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Extracting Information

•  Who is the patient? Consider age and gender.

•  What is the patient’s history? Does the patient smoke or drink? Does the patient exercise? Is he/she overweight?

•  What are the patient’s symptoms? Consider what the symptoms are, whether the symptoms change and if the symptoms get better or worse.

Making a Differential Diagnosis

•  What body system(s) is/are affected?

•  Are the symptoms localized or systemic?

•  Does the patient have a fever? Fever often indicates an infectious disease.

Gathering Information

•  Consider where you are getting the information. Is the source credible?

•  Consider typing symptoms into Google. Refer to websites that are from government agencies (ex. CDC, NIH), hospitals (Mayo Clinic, Cleveland Clinic) and/or other credible sites such as Merck Manual and WHO.

Analyzing Information

•  Consider each of the possible diseases on your differential diagnosis one at a time. Rule out the least likely diseases first.

•  Consider the most common symptoms vs. least common symptoms of the disease when narrowing down to the final diagnosis.

•  Make sure lab test findings agree with your final diagnosis.

© Stephanie Elkowitz

Name:____________________________

Disease PBL Activities Student Guide

Overview

In these activities, you will problem-solve to diagnose diseases. You will be provided with information in a short report (called a patient history) for each patient. The information provides clues as to what disease the patient is suffering from. Follow the directions below. Use the accompanying worksheet to help you problem-solve and organize information. Use the reflection worksheet to answer questions after you diagnose the patient.

Student Directions:

1.  Read through the case.

2.  Extract important information about the the patient. Consider the patient’s age, gender, recent activities and social behaviors.

3.  Extract information about the patient’s symptoms. Consider what the symptoms are, how long the patient has had those symptoms and if the symptoms are getting better or worse.

4.  Use books and/or the internet to research possible diseases that could be causing the patient’s symptoms. List at least 5 possible diseases. This list of possible diseases is called a differential diagnosis.

5.  Work in groups to determine which disease listed in your differential diagnosis is most likely making the patient sick. In order to do this:

1.  Form a plan. What information do you need to find out? Assign tasks to each member of your group.

2.  Gather information. Each member of the group should use books and/or the internet to research diseases in your the differential diagnosis.

3.  Analyze information. Work as a group to analyze the information to determine a final diagnosis.

4.  Solve the problem. Make a final diagnosis.

6.  After diagnosing the disease, answer the pre-reflection questions on the reflection worksheet.

7.  As your teacher gives you the correct diagnosis, complete the post-answer questions.

8.  After your teacher gives you the correct diagnosis, complete the reflection essays.

PBL Activities: Diseases 7 © Stephanie Elkowitz

Name:____________________________ Case #_____

Information Recording Sheet

Extract information. What information is provided in the report?

Differential Diagnosis. What diseases could be causing the patient’s symptoms?

Create a plan. What information do you have to find out?

Gather information. What did you discover?

Analyze. What does all the information mean?

Solve the problem. What disease does the patient have?

PBL Activities: Diseases 8 © Stephanie Elkowitz

Name:____________________________

Reflection Worksheet

Pre-Reflection

1.  What test(s) would you need to perform to confirm your diagnosis?

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2.  How is the disease treated?

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3.  What is the prognosis of the disease?

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Post-Answer Questions

1.  What is the correct diagnosis? ________________________________________

2.  What test(s) would confirm this diagnosis?

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3.  How would the disease be treated?

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4.  What is the prognosis of the disease?

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PBL Activities: Diseases 9 © Stephanie Elkowitz

Reflection Worksheet continued

Reflection

Part 1

Consider: How well did you extract information from the patient history? How well did you (and your group) gather additional information? How well did you (and your group) analyze information to come up with a final diagnosis? Was your diagnosis correct? If not, what did you overlook or misinterpret?

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Part 2

Consider: How well did your group work together? Consider how you communicated with each other, your ability to stay focused and how well everyone participated. Also consider how you could improve the group performance for the next activity.

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PBL Activities: Diseases 10 © Stephanie Elkowitz

Name:____________________________

Disease PBL Activities Student Dictionary

Use this sheet to help you understand medical terms used in the activities.

Antigen: A protein on a cell that identifies what that cell is.

BMI (Body Mass Index): A measure of a person’s body fat based on height and weight. It helps determine if a person is at a healthy weight.

CBC (Complete Blood Count): A blood test that measures the number of blood cells (red blood cells, white blood cells and platelets) and other features in a person’s blood.

Diagnosis: The identification of a disease that is causing a person’s symptoms.

Differential Diagnosis: A list of possible diseases that could be causing a person’s symptoms.

EKG (aka ECG): An electrocardiogram is a test that checks for problems with electrical activity of the heart.

Hemoglobin: The protein in red blood cells that carries oxygen.

Malaise: A general feeling of discomfort

Murmur: A sound made by the heart, such as a whooshing or swishing. This is an extra sound and can indicate an abnormality or disease of the heart

Patient History: Information gained by a doctor by asking specific questions. The patient history tells the doctor about the patient’s medical and health experiences.

Prognosis: The likely outcome of the disease.

Stethoscope: A tool used to listen to heart and breath sounds.

Symptoms: The effects a person experiences as a result of a disease.

PBL Activities: Diseases 11 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #1

Patient History:

A 35 year old male arrives at the emergency room complaining of fever, headache and fatigue. He started experiencing these symptoms about two weeks ago, just when he returned back to the United States from Ghana.

The patients complains most about his fever. He says that it comes and goes every couple of days. When he doesn’t have a fever, he has shaking chills.

The patient does not drink or smoke. He exercises 3 days a week, but has not been well enough to exercise since he began feeling sick.

The doctor orders a CBC and a urine test. The CBC indicates the patient’s red blood cell count is low and white blood cell count is high. The urine test indicates the patient is excreting hemoglobin in his urine.

What’s your diagnosis?

PBL Activities: Diseases 12 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #2

Patient History:

A 48 year old male is rushed to the emergency by his wife. He was shoveling snow off his driveway when he began to experience severe chest pain. The patient said the pain felt like a heavy pressure or squeezing in his chest. The pain was so severe that it extended into his back and down his left arm. Since arriving to the emergency room, the pain has subsided.

When asked, the patient informed the doctor that he smokes a pack of cigarettes a day. He does not drink. He is obese, with a BMI of 32. He does not exercise.

The doctor orders blood work and an EKG. The patient waits in the emergency room to have these tests performed.

What’s your diagnosis?

PBL Activities: Diseases 13 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #3

Patient History:

A 16 year old male comes to the emergency room complaining of muscle and joint pain. The male explains that the pain seems to move around his body, affecting a different joint each day.

The patient admits to having a fever, body aches and malaise about 2 week ago. He developed these symptoms after a camping trip on Long Island, New York. During his trip, the patient developed a rash, which he assumed was due to exposure to Poison Ivy.

The patient does not drink or smoke. He is very active and participates on the soccer and baseball school teams. He has a healthy BMI of 23.

The doctor orders a CBC and urine test. The CBC shows the patient’s white blood cell count is high. The urine test was negative.

What’s your diagnosis?

PBL Activities: Diseases 14 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #4

Patient History:

A 22 year old female presents to the emergency room with a rash on the palm of her hands. The rash is reddish-pink a n d n o t i t c h y . T h e p a t i e n t a l s o complains of headache, fever and a sore throat.

Upon examination, the doctor finds the same rash on the soles of her feet. He also palpates (feels) swollen lymph nodes in her neck and under her arms. The also notices excess hair on the back of the woman’s shirt. When he examines her scalp, he finds that her hair is thinning and falling out easily.

The patient does not smoke or drink. She is sexually active and admits to having unprotected sex about 2 months ago. She has a healthy BMI of 22.

What’s your diagnosis?

PBL Activities: Diseases 15 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #5

Patient History:

A 12 year old female is brought to the emergency room by her mother. The patient has a fever and is complaining of pain in her knees, hips, elbows and fingers. She also has pain in her chest and feels like her heart is racing.

The doctors asks the mother questions about her daughter’s health. The mother tells the doctor that her daughter has always been a healthy and active girl. About 2 weeks ago, her daughter had a sore throat. There was a white film in the back of her daughter’s throat, but her daughter wasn’t complaining of feeling ill so she didn’t bring her to the doctor.

The doctor examines the patient. He listens to her heart and hears a murmur. He orders an EKG and blood work. The patient waits in the emergency room to have the tests performed.

What’s your diagnosis?

PBL Activities: Diseases 16 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #6

Patient History:

A 70 year old male is complaining of shortness of breath and a persistent cough. He began experiencing these symptom a couple months ago. They have progressively gotten worse. This morning he coughed up blood, which prompted him to see a doctor.

The patient does not drink but admits to smoking 2 packs of cigarettes a day since he was 18 years old. He is overweight with a BMI of 26.

The doctor listens to the patient’s lungs with a stethoscope. He hears decreased breath sounds in the upper left area of the lungs. He also examines the patient’s body. He notices that the patient’s fingertips are rounded and look like clubs.

What’s your diagnosis?

PBL Activities: Diseases 17 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #7

Patient History:

A 15 year old girl is brought to the emergency room by her parents. For the past two days, the girl has experienced a severe headache, high fever, nausea and vomiting. This morning she woke up with a rash on her hands and feet. The rash is small and flat pink spots. The rash does not itch. Her parents brought their daughter to the emergency room because the rash seems to be spreading up her arms and legs.

The patient has no significant medical history. Before this illness, the patient was active and healthy. In fact, the patient was hiking the Appalachian mountains in North Carolina right before she became ill.

The doctor orders a CBC and a chemistry panel. The tests show a low platelet count, low sodium levels and elevated liver enzymes.

What’s your diagnosis?

PBL Activities: Diseases 18 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #8

Patient History:

A 25 year old male presents to the emergency room with severe abdominal pain, diarrhea and bloody stool. The p a t i e n t b e g a n e x p e r i e n c i n g t h e s e symptoms one week ago.

The doctor questions the patient. The patient admits to drinking one or two drinks a day and smokes one pack of cigarettes a week. The patient also states he traveled to Egypt last month. He enthusiastically told the doctor the most exciting part of his trip was swimming in the Nile River.

The doctor examines the patient. While palpating the abdomen, the doctor discovers the patient’s liver and spleen are enlarged. He orders a CBC. The blood work shows an extremely high eosinophil count and slightly low red blood cell count.

What’s your diagnosis?

PBL Activities: Diseases 19 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #9

Patient History:

A 6 year old male is brought to the emergency room by his mother. For the past three days, the boy has run a very high fever of 104.2°F. The patient also has been complaining of a runny nose, red eyes and a cough.

The doctor begins examining the patient. He observes small white spots inside the boy’s mouth. He also observes a red, flat rash behind the boy’s ears.

The doctor then speaks to the mother about the boy’s general health. The boy is active, but slightly overweight. When asked about immunizations, she states that her son’s immunizations are not up to date.

What’s your diagnosis?

PBL Activities: Diseases 20 © Stephanie Elkowitz

Name:____________________________ NOTES:

Case #10

Patient History:

A 35 year old female presents to her doctor with a blotchy lesions on her legs, back and face. The lesions are raised and vary in color. Some are red while others are brown and black. The patient is also experiencing a cough, fever and diarrhea.

The doctor takes the patient’s history. The female does not smoke or drink. She is single and not sexually active. She admits to using heroine and other illicit drugs in her 20s. The patient admits to losing a significant amount of weight over the past year. She was not intending to lose weight. She is underweight with a BMI is 16.

The doctor orders a CBC. The blood work shows an extremely low CD4 count (150 cells per uL).

What’s your diagnosis?

PBL Activities: Diseases 21 © Stephanie Elkowitz

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