NR547 CASE STUDY: BETTY BURNS -
x x x x x
EVALUATION AND MANAGEMENT OF SELF-
x x x x x
DETECTED BREAST LUMP IN A 48-YEAR-
x x x x x x
OLD FEMALE (NR 547)
x x x
BettyxBurns
Chiefxcomplaint:
Self-detectedxbreastxlump
BelowxarexthexinstructionsxforxplayingxthisxDDx.xcasexandxyourxgradingxrubric:xNotexyouxwillxbexallowedxtoxpushxt
hexInterviewxProgressxButtonxandxreceivexfeedbackxonxyourxhistoryxquestionsx10xtimes.
a) %xrequiredxhistoryxquestionsxyouxaskedx(30%xofxgrade)
b) %xrequiredxphysicalxexamxperformedx(30%xofxgrade)
c) differentialxdiagnosesxlistx(15%)
d) rankingxdifferentialxdiagnosisxlistx(10%)
e) laboratoryxtestsxorderedx(15%)
Noticexthatxgettingxthexcorrectxfinalxdiagnosisxisxnotxpartxofxthexgradedxcase.xThisxisxbecausexifxyouxdoxwellxinxea
chxofxthexotherxparts,xyouxWILLxgetxthexcorrectxdiagnosis.xThexsoftwarexplatformxisxdesignedxtoxhelpxyouxbeco
mexproficientxinxthexdiagnosticxreasoningxprocessx(allxthexstepsxpriorxtoxthexfinalxdiagnosis),xsoxyouxcanxapplyxth
isxprocessxinxthexrealxclinicxsetting.xKeyxtoxminimizingxmedicalxerrorsxisxthexclinicalxconsiderationxofxaxbroadxdiffe
rentialxdiagnosisxlistxandxthexselectionxofxtestsxtoxeitherx“rulexin”xorx“rulexout”xthesexdiagnoses.
****xHELPFULxHINTSx****
ThexAvatarsxandxcasesxinxthexIHPxcasexlibraryxarexbasedxonx“realxpatients”.xIfxthexAvatarxprovidesxconfusingxinfo
rmation,xthisxisxintentionalxasxwexoftenxwhatxwexfindxrealxpatientsxprovidexincongruentxinformation.xForxexamp
le,xthexAvatarxmayxusexthextermx“rash”xforxskinxlesionsxthatxarexnotxbyxmedicalxdefinitionxaxrash---
justxlikexrealxpatients.xAvatarsxmayxrefusextoxanswerxquestions,xjustxlikexrealxpatients.xPhrasingxofxquestionsxIS
important.xAskingxax“similar”xquestionxthatxisxlessxspecificxmayxnotxbexscoredxcorrectxifxitxdoesxnotxprovidexthexc
larityxofxinformationxneededxtoxnarrowxthexdifferential.xAllxofxthesexsmallxnuancesxinxthexcasexdesignxwerexinte
ntionalxandxreplicatexthexchallengesxyouxwillxfacexwithxrealxpatientsxinxaxclinicalxsetting.xMyxrecommendationxis
xtoxpretendxthisxisxaxrealxclinicalxpatientxencounterxandxselectxaxtimexsoxyouxcanxenjoyxthexprocessxandxnotxfeelx
pressuredxforxtime.xRemember,xyouxarexnotxscoredxonxwhetherxyouxgetxthexdiagnosisxcorrect,xbutxratherxhavex
youxmasteredxthexprocess.xMasteryxofxthexprocessxwillxhelpxyouxavoidxmakingxdiagnosticxerrorsxthroughoutxyo
urxclinicalxcareer.
Detailedx Instructionsx Below:
1. Takexthexpatient'sxhistory.
,NR547 CASE STUDY: BETTY BURNS -
x x x x x
EVALUATION AND MANAGEMENT OF SELF-
x x x x x
DETECTED BREAST LUMP IN A 48-YEAR-
x x x x x x
OLD FEMALE (NR 547)
x x x
• Decidexofxthisxisxaxpatientxthatxcanxbextreatedxasxanxoutpatient;xfocusedxcasex–
xfewerxhistoryxquestionsxneededxversusxaxcomprehensivexcasexwherexallxcomponentsxofxaxhistory.
• Documentxthexchiefxcomplaint
• Documentxanyxabnormalxhistoryxorxcomplaintsxonxyourxproblemxlist
• ThexInterviewxProgressxButtonxcanxbexusedxupxtox10xtimesxonxthexpracticexcasesxonlyxtoxgivexyoux
feedbackxonxhowxclosexyouxarextoxaskingxallxthexauthorsx“requiredxquestions”.
2. ProceedxtoxperformxaxPHYSICALxEXAM.
• Assessxvitalxsignsxandxperformxthexexaminationxappropriatexforxthextypexofxcasexidentifiedxbyxthex
abovexhistory.xRememberxthexcomprehensivexcasesxrequirexaxcomprehensivexphysical.x
Documentxabnormalxfindingsxinxyourxproblemxlist.
3. Bexsurextoxcompletexthexproblemxlistxexercise.
• Thexdirectionsxwillxtellxyouxhowxmanyxitemsxshouldxbexchosen.xDOxNOTxexceedxthatxnumberxorxyourx
scorexwillxbexzero.
4. Writexaxconcisexproblemxstatement.
• StartxwithxaxdemographicxdescriptionxofxyourxpatientxandxthexchiefxcomplaintxandxMSAP.xTryxtoxkeepx
yourxproblemxstatementxbelowx100xwords.xAlthoughxthisxwillxnotxcountxtowardsxyourxfinalxcasexscore,x
itxwillxallowxyouxtoxpracticexlearningxtoxcommunicatexpatientxinformationxinxaxcompletexandxconcisexfa
shion.
5. Finalizexyourxdifferentialxdiagnosisxlist.
• Youxmayxstartxyourxdifferentialxdiagnosisxduringxthexhistoryxtakingxsection,xbutxafterxcompletingxthex
problemxstatement,xreflectxandxfinalizexyourxdifferentialxdiagnosisxlist.xRemember,xthisxpartxofxthexc
asexwillxbexscoredxonxhowxcomprehensivexthisxlistxis.xYouxwillxnotxlosexpointsxforxhavingxtooxmany,xp
ointsxarexlostxonlyxifxyouxhavextooxfew.xThexaveragexlistxcontainsx5xdiagnoses.
6. OrderxTests
• Orderxeachxtestxandxlinkxitxtoxaxdiagnosis.xSomextestsxarexorderedxtox“rulexin”xaxdiagnosisxwhilexothersx
arexorderedxtox“rulexout”xaxdiagnosis.
DOxNOTxtryxtoxscamxthexsystemxbyxjustxclickingxonxeverything.xThexsoftwarextracksxnotxonlyxwhatxisxdone,xbutxa
lsoxkeepsxtrackxofxthexorderxofxcompletion.xClickingxonxthexfirstxopeningxquestionxandxthenxjustxgoingxdownxthe
xlistxofxquestionsxinxthexhistory xisxviewedxasx“scamming”xthexsystemxandxcanxresultxinxaxscorexofxZERO---
xsamexprinciplexappliesxtoxeachxsection.xThextimexforxcompletionxofxthexcase,xasxwellxasxtimexspentxinxeachxsecti
onxofxthexcasexisxalsoxrecorded.xThisxdataxhasxbeenxshownxtoxcorrelatexwithxcasexperformance.xVeryxshortxtimes
xhavexlowerxscoresxasxdoxveryxlongxtimes.xThexformerxisxmost xlikelyxduextoxlackxofxeffortxwhilexthexlatterxmayxbe
xbecausexthexuserxisxreceivingxmultiplexinterruptions.xThexlowxscorexthenxmostxlikelyxreflectsx“lackxofxcontinuity
”xofxthought.xTryxtoxsetxasidexenoughxtimextoxcompletexthexcasexinxitsxentiretyxinxaxsinglexsitting.
Thisxsoftwarexisxaimedxatxtryingxtoxhelpxassessxyourxcriticalxthinkingxandxdiagnosticxreasoningxskillsxwithxpatient
sxsimilarxtoxthosexyouxwillxbexseeingxinxthexclinicalxsetting.x Itxisxextremelyximportantxforxyouxtoxtakexthesexcases
xseriouslyxasxtheyxwillxbexusedxtoxdeterminexhowxappropriatexyourxinteractionsxarexwithxpatientsxandxifxyourxclin
icalxdecisionxmakingxskillsxarexappropriatexforxthisxlevelxinxthexprogram.
, NR547 CASE STUDY: BETTY BURNS -
x x x x x
EVALUATION AND MANAGEMENT OF SELF-
x x x x x
DETECTED BREAST LUMP IN A 48-YEAR-
x x x x x x
OLD FEMALE (NR 547)
x x x
HISTORY
Youxaskedx66xquestions.x10x(15%)xwerexkeyxquestionsxsuggestedxbyxthexexpertxcasexauthor.xYouxaskedxanxadditi
onalx56xquestionsx(85%).
Missing
Oops.xYouxdidn'txaskxallximportantxquestionsxsuggestedxbyxthexexpertxauthorxforxthisxcase.xYouxmissedxaskingx1
1xofxthex21xkeyxquestions.x(Note:xSometimesxtherexisxmorexthanxonexwayxtoxgetxsimilarxinformationxfromxyourxp
atient.xElicitingxinformationxinxmorexthanxonexwayxwhenxinterviewingxaxpatientxcanxbexuseful.)
Missingxquestionsxare:
AssociatedxSx/SxxCharacteristics:
• Doxyouxhavexanyxbreastxlumpxorxdischarge?
RiskxFactors:
PMH:
• Anyxnewxorxrecentxchangexinxmedications?
HPI/ROS:
• Doxyouxhavexanyxofxthexfollowingxproblems:xfatigue,xdifficultyxsleeping,xunintentionalxweightxlossxorx
gain,xfevers,xnightxsweats?
• Doxyouxhavexanyxproblemsxwith:xheadachesxthatxdon’txgoxawayxwithxaspirinxorxTylenolx(acetamino
phen),xdoublexorxblurredxvision,xdifficultyxwithxnightxvision,xproblemsxhearing,xearxpain,xsinusxprobl
ems,xchronicxsorexthroats,xdifficultyxswallowing?
• Doxyouxexperience:xchestxpain,xdiscomfort,xpressure,xpain/pressure/dizzinessxwithxexertionxorxgettingx
angry,xpalpitations,xdecreasedxexercisextolerance,xblue/coldxfingersxandxtoes?
• Doxyouxexperience:xshortnessxofxbreath,xwheezing,xdifficultyxcatchingxyourxbreath,xchronicxcough,x
sputumxproduction?
• Doxyouxhavexproblemsxwith:xnausea,xvomiting,xconstipation,xdiarrhea,xcoffeexgroundsxinxyourxvomit,x
darkxtarryxstool,xbrightxredxbloodxinxyourxbowelxmovements,xearlyxsatiety,xbloating?
• Havexyouxnoticed:xanyxbruising,xbleedingxgumsxorxotherxsitesxofxincreasedxbleeding?
• Doxyouxhavexanyxofxthexfollowing:xheatxorxcoldxintolerance,xincreasedxthirst,xsweating,xfrequentx
urination,xchangexinxappetite?
• Doxyouxhavexanyxofxthexfollowing:xdizziness,xfainting,xspinningxroom,xseizures,xweakness,xnumbness,x
tingling,xtremor?
• Whenxyouxurinate,xhavexyouxnoticed:xpain,xdifficultyxstartingxorxstopping,xdribbling,xincontinence,x
urgencyxduringxdayxorxnight.xAnyxchangesxinxfrequency?xAnyxbloodxinxyourxurine?
Reminder:
BexsurextoxfillxoutxappropriatexportionsxofxthexPatientxRecordxbeforexproceeding.
x x x x x
EVALUATION AND MANAGEMENT OF SELF-
x x x x x
DETECTED BREAST LUMP IN A 48-YEAR-
x x x x x x
OLD FEMALE (NR 547)
x x x
BettyxBurns
Chiefxcomplaint:
Self-detectedxbreastxlump
BelowxarexthexinstructionsxforxplayingxthisxDDx.xcasexandxyourxgradingxrubric:xNotexyouxwillxbexallowedxtoxpushxt
hexInterviewxProgressxButtonxandxreceivexfeedbackxonxyourxhistoryxquestionsx10xtimes.
a) %xrequiredxhistoryxquestionsxyouxaskedx(30%xofxgrade)
b) %xrequiredxphysicalxexamxperformedx(30%xofxgrade)
c) differentialxdiagnosesxlistx(15%)
d) rankingxdifferentialxdiagnosisxlistx(10%)
e) laboratoryxtestsxorderedx(15%)
Noticexthatxgettingxthexcorrectxfinalxdiagnosisxisxnotxpartxofxthexgradedxcase.xThisxisxbecausexifxyouxdoxwellxinxea
chxofxthexotherxparts,xyouxWILLxgetxthexcorrectxdiagnosis.xThexsoftwarexplatformxisxdesignedxtoxhelpxyouxbeco
mexproficientxinxthexdiagnosticxreasoningxprocessx(allxthexstepsxpriorxtoxthexfinalxdiagnosis),xsoxyouxcanxapplyxth
isxprocessxinxthexrealxclinicxsetting.xKeyxtoxminimizingxmedicalxerrorsxisxthexclinicalxconsiderationxofxaxbroadxdiffe
rentialxdiagnosisxlistxandxthexselectionxofxtestsxtoxeitherx“rulexin”xorx“rulexout”xthesexdiagnoses.
****xHELPFULxHINTSx****
ThexAvatarsxandxcasesxinxthexIHPxcasexlibraryxarexbasedxonx“realxpatients”.xIfxthexAvatarxprovidesxconfusingxinfo
rmation,xthisxisxintentionalxasxwexoftenxwhatxwexfindxrealxpatientsxprovidexincongruentxinformation.xForxexamp
le,xthexAvatarxmayxusexthextermx“rash”xforxskinxlesionsxthatxarexnotxbyxmedicalxdefinitionxaxrash---
justxlikexrealxpatients.xAvatarsxmayxrefusextoxanswerxquestions,xjustxlikexrealxpatients.xPhrasingxofxquestionsxIS
important.xAskingxax“similar”xquestionxthatxisxlessxspecificxmayxnotxbexscoredxcorrectxifxitxdoesxnotxprovidexthexc
larityxofxinformationxneededxtoxnarrowxthexdifferential.xAllxofxthesexsmallxnuancesxinxthexcasexdesignxwerexinte
ntionalxandxreplicatexthexchallengesxyouxwillxfacexwithxrealxpatientsxinxaxclinicalxsetting.xMyxrecommendationxis
xtoxpretendxthisxisxaxrealxclinicalxpatientxencounterxandxselectxaxtimexsoxyouxcanxenjoyxthexprocessxandxnotxfeelx
pressuredxforxtime.xRemember,xyouxarexnotxscoredxonxwhetherxyouxgetxthexdiagnosisxcorrect,xbutxratherxhavex
youxmasteredxthexprocess.xMasteryxofxthexprocessxwillxhelpxyouxavoidxmakingxdiagnosticxerrorsxthroughoutxyo
urxclinicalxcareer.
Detailedx Instructionsx Below:
1. Takexthexpatient'sxhistory.
,NR547 CASE STUDY: BETTY BURNS -
x x x x x
EVALUATION AND MANAGEMENT OF SELF-
x x x x x
DETECTED BREAST LUMP IN A 48-YEAR-
x x x x x x
OLD FEMALE (NR 547)
x x x
• Decidexofxthisxisxaxpatientxthatxcanxbextreatedxasxanxoutpatient;xfocusedxcasex–
xfewerxhistoryxquestionsxneededxversusxaxcomprehensivexcasexwherexallxcomponentsxofxaxhistory.
• Documentxthexchiefxcomplaint
• Documentxanyxabnormalxhistoryxorxcomplaintsxonxyourxproblemxlist
• ThexInterviewxProgressxButtonxcanxbexusedxupxtox10xtimesxonxthexpracticexcasesxonlyxtoxgivexyoux
feedbackxonxhowxclosexyouxarextoxaskingxallxthexauthorsx“requiredxquestions”.
2. ProceedxtoxperformxaxPHYSICALxEXAM.
• Assessxvitalxsignsxandxperformxthexexaminationxappropriatexforxthextypexofxcasexidentifiedxbyxthex
abovexhistory.xRememberxthexcomprehensivexcasesxrequirexaxcomprehensivexphysical.x
Documentxabnormalxfindingsxinxyourxproblemxlist.
3. Bexsurextoxcompletexthexproblemxlistxexercise.
• Thexdirectionsxwillxtellxyouxhowxmanyxitemsxshouldxbexchosen.xDOxNOTxexceedxthatxnumberxorxyourx
scorexwillxbexzero.
4. Writexaxconcisexproblemxstatement.
• StartxwithxaxdemographicxdescriptionxofxyourxpatientxandxthexchiefxcomplaintxandxMSAP.xTryxtoxkeepx
yourxproblemxstatementxbelowx100xwords.xAlthoughxthisxwillxnotxcountxtowardsxyourxfinalxcasexscore,x
itxwillxallowxyouxtoxpracticexlearningxtoxcommunicatexpatientxinformationxinxaxcompletexandxconcisexfa
shion.
5. Finalizexyourxdifferentialxdiagnosisxlist.
• Youxmayxstartxyourxdifferentialxdiagnosisxduringxthexhistoryxtakingxsection,xbutxafterxcompletingxthex
problemxstatement,xreflectxandxfinalizexyourxdifferentialxdiagnosisxlist.xRemember,xthisxpartxofxthexc
asexwillxbexscoredxonxhowxcomprehensivexthisxlistxis.xYouxwillxnotxlosexpointsxforxhavingxtooxmany,xp
ointsxarexlostxonlyxifxyouxhavextooxfew.xThexaveragexlistxcontainsx5xdiagnoses.
6. OrderxTests
• Orderxeachxtestxandxlinkxitxtoxaxdiagnosis.xSomextestsxarexorderedxtox“rulexin”xaxdiagnosisxwhilexothersx
arexorderedxtox“rulexout”xaxdiagnosis.
DOxNOTxtryxtoxscamxthexsystemxbyxjustxclickingxonxeverything.xThexsoftwarextracksxnotxonlyxwhatxisxdone,xbutxa
lsoxkeepsxtrackxofxthexorderxofxcompletion.xClickingxonxthexfirstxopeningxquestionxandxthenxjustxgoingxdownxthe
xlistxofxquestionsxinxthexhistory xisxviewedxasx“scamming”xthexsystemxandxcanxresultxinxaxscorexofxZERO---
xsamexprinciplexappliesxtoxeachxsection.xThextimexforxcompletionxofxthexcase,xasxwellxasxtimexspentxinxeachxsecti
onxofxthexcasexisxalsoxrecorded.xThisxdataxhasxbeenxshownxtoxcorrelatexwithxcasexperformance.xVeryxshortxtimes
xhavexlowerxscoresxasxdoxveryxlongxtimes.xThexformerxisxmost xlikelyxduextoxlackxofxeffortxwhilexthexlatterxmayxbe
xbecausexthexuserxisxreceivingxmultiplexinterruptions.xThexlowxscorexthenxmostxlikelyxreflectsx“lackxofxcontinuity
”xofxthought.xTryxtoxsetxasidexenoughxtimextoxcompletexthexcasexinxitsxentiretyxinxaxsinglexsitting.
Thisxsoftwarexisxaimedxatxtryingxtoxhelpxassessxyourxcriticalxthinkingxandxdiagnosticxreasoningxskillsxwithxpatient
sxsimilarxtoxthosexyouxwillxbexseeingxinxthexclinicalxsetting.x Itxisxextremelyximportantxforxyouxtoxtakexthesexcases
xseriouslyxasxtheyxwillxbexusedxtoxdeterminexhowxappropriatexyourxinteractionsxarexwithxpatientsxandxifxyourxclin
icalxdecisionxmakingxskillsxarexappropriatexforxthisxlevelxinxthexprogram.
, NR547 CASE STUDY: BETTY BURNS -
x x x x x
EVALUATION AND MANAGEMENT OF SELF-
x x x x x
DETECTED BREAST LUMP IN A 48-YEAR-
x x x x x x
OLD FEMALE (NR 547)
x x x
HISTORY
Youxaskedx66xquestions.x10x(15%)xwerexkeyxquestionsxsuggestedxbyxthexexpertxcasexauthor.xYouxaskedxanxadditi
onalx56xquestionsx(85%).
Missing
Oops.xYouxdidn'txaskxallximportantxquestionsxsuggestedxbyxthexexpertxauthorxforxthisxcase.xYouxmissedxaskingx1
1xofxthex21xkeyxquestions.x(Note:xSometimesxtherexisxmorexthanxonexwayxtoxgetxsimilarxinformationxfromxyourxp
atient.xElicitingxinformationxinxmorexthanxonexwayxwhenxinterviewingxaxpatientxcanxbexuseful.)
Missingxquestionsxare:
AssociatedxSx/SxxCharacteristics:
• Doxyouxhavexanyxbreastxlumpxorxdischarge?
RiskxFactors:
PMH:
• Anyxnewxorxrecentxchangexinxmedications?
HPI/ROS:
• Doxyouxhavexanyxofxthexfollowingxproblems:xfatigue,xdifficultyxsleeping,xunintentionalxweightxlossxorx
gain,xfevers,xnightxsweats?
• Doxyouxhavexanyxproblemsxwith:xheadachesxthatxdon’txgoxawayxwithxaspirinxorxTylenolx(acetamino
phen),xdoublexorxblurredxvision,xdifficultyxwithxnightxvision,xproblemsxhearing,xearxpain,xsinusxprobl
ems,xchronicxsorexthroats,xdifficultyxswallowing?
• Doxyouxexperience:xchestxpain,xdiscomfort,xpressure,xpain/pressure/dizzinessxwithxexertionxorxgettingx
angry,xpalpitations,xdecreasedxexercisextolerance,xblue/coldxfingersxandxtoes?
• Doxyouxexperience:xshortnessxofxbreath,xwheezing,xdifficultyxcatchingxyourxbreath,xchronicxcough,x
sputumxproduction?
• Doxyouxhavexproblemsxwith:xnausea,xvomiting,xconstipation,xdiarrhea,xcoffeexgroundsxinxyourxvomit,x
darkxtarryxstool,xbrightxredxbloodxinxyourxbowelxmovements,xearlyxsatiety,xbloating?
• Havexyouxnoticed:xanyxbruising,xbleedingxgumsxorxotherxsitesxofxincreasedxbleeding?
• Doxyouxhavexanyxofxthexfollowing:xheatxorxcoldxintolerance,xincreasedxthirst,xsweating,xfrequentx
urination,xchangexinxappetite?
• Doxyouxhavexanyxofxthexfollowing:xdizziness,xfainting,xspinningxroom,xseizures,xweakness,xnumbness,x
tingling,xtremor?
• Whenxyouxurinate,xhavexyouxnoticed:xpain,xdifficultyxstartingxorxstopping,xdribbling,xincontinence,x
urgencyxduringxdayxorxnight.xAnyxchangesxinxfrequency?xAnyxbloodxinxyourxurine?
Reminder:
BexsurextoxfillxoutxappropriatexportionsxofxthexPatientxRecordxbeforexproceeding.
