1. 40% = History questions
  2. 30% = Physical exam
  3. 10% = Differential diagnosis list
  4. 10% = Ranking the differential diagnosis
  5. 10% = Lab test
  6. 0% = Science exercises
  7. 0% = Management plan – faculty scores this.
Case Help HISTORY:
  • Patient interview reminder sheet - document in key findings
  • “Good Question” means you asked a required question
Step 1: Start by asking 2 open-ended patient-centric questions:
  1. How can I help you today?
  2. Any other symptoms or concerns?
Step 2: Obtain an HPI using “OLDCARTS”
  • O = Onset, circumstances surrounding start of symptom
  • L = Location, radiation
  • D = Duration
  • C = Characteristics (sharp, dull, cramping)
  • A = Aggravating
  • R = Relieving
  • T = Treatments
  • S = Severity
Step 3: PMH
  • No patient record – Obtain history
  • Have patient record – Update allergies, medications, OTC drugs
Step 4: FH
  • No patient record – Obtain history
Step 5: SH
  • No patient record - obtain history
  • Have patient record - Update if major changes in living situation, death of partner, loss of job, etc.
Step 6: ROS
  • Questions for systems not addressed in HPI
  • Choose ROS for the body systems you do not have information on. Use the large multipart questions
Physical Exam
  • Do those physical assessment maneuvers as needed
  • Choose ROS for those body systems you do not have information on. Use large multipart questions.
Assessment
  • Organize key findings list by selecting the MSAP (Most significant active problem).
  • Mark other findings as: related, unrelated, unknown, PMH/resolved.
Problem Statement
  • Short summary of patient’s presentation. Should contain:
    1. Demographic description,
    2. Chief complaint,
    3. Hx and PE key findings,
    4. Risk factors.
  • Keep it concise.
Differential Diagnosis
  • List disease you are considering Prior to ordering tests.
Tests:
  • Determine what tests are needed to rule in or rule out each diagnosis on authors corrected list.
  • Review authors corrected list of test results.
Final Diagnosis
  • Select a final diagnosis or diagnoses.
Treatment plan
  • Write a treatment plan following your instructors’ guidelines.
Gear head exercises
  • Complete exercises found throughout the case (look for the brain with gears icon in steps of the case)
Summary
  • Proceed all the way to the “Summary” tab.
  • Submit your case and press the “see evaluation” button to see your first evaluation.
Ebony Gray 25 y/o 5’6 (168cm) 140.0 lb (63.6kg) A&Ox4 Vital Signs
  • Temp: 37.1 (98.7)
  • Pulse: 78 bpm, rhythm: regular, strength: normal
  • BP L/arm 110/72, R/arm 110/72, assessment: normal, pulse pressure: normal
  • RR: 14 bpm, rhythm: regular, effort: unlabored
  • SpO2: 94%
CC: 25 y/o desires contraception HISTORY: Good Questions:
  • 2 Open-ended questions:
    1. How can I help you today?
    2. Any other symptoms or concerns?
HX Final Questions:
  • How can I help you today?