Case Name & Day Restriction of Use: The School of Medicine considers all PBL cases and supporting materials to be secure and intended solely for the educational purposes of the students and faculty of the University of Texas Medical Branch. Students should not access the PBL cases prior to release on the course website. At no time should the PBL cases and supporting materials be copied or distributed. Individuals violating these policies are subject to disciplinary action.

Background This slide includes: An introduction of the patient from his/her background story up to the reason for the visit (possibly including a history of present illness). Go through the PBL Process before moving to the next slide. Start Problem and Hypotheses Lists on the whiteboard.

Past Medical History Go through PBL Process before moving to next slide. Continue Problem and Hypotheses Lists. What additional information would you like to know and how would you obtain it?

Family History Go through PBL Process before moving to next slide. Continue Problem and Hypotheses Lists. What additional information would you like to know and how would you obtain it?

Social History Go through PBL Process before moving to next slide. Continue Problem and Hypotheses Lists. What would you want to learn from the physical exam?

Physical Exam Review of Systems Physical Findings Go through PBL Process before moving to next slide. Continue Problem List as needed and revise and prioritize the Hypotheses List

Tasks This slide might include: Can you form hypotheses regarding pathogenesis based on the problem list? List them on whiteboard. Consider VITAMIN ABCDE. What other information would you like to have about the patient to confirm or disconfirm hypotheses? How could you get the information you need? VITAMIN ABCDE Vascular Inflammatory Trauma/Toxin Autoimmune Metabolic/Medication Infection Neoplastic Acquired Biopsychosocial Congenital Degenerative Endocrine/Electrical Discuss the above tasks (if not already discussed) before proceeding to next slide.

Additional Information This slide might include: Information from questions asked of the patient Lab values Exhibits Revise the problem list as needed. Revise and prioritize Hypotheses List based on new information.

Exhibit 1 This slides will include: Exhibits that are embedded within the case (rather than hyperlinked at the end of the case).

Tasks This slide might include: Pharmacology Possible treatment choices Additional information needed about this patient Diagrams Discuss the above tasks (if not already discussed) before proceeding to next slide.

Please turn off projector using the wall-mounted key pad. Thank you. End Day 1 Please turn off projector using the wall-mounted key pad. Thank you.

Case Name & Day Begin Day 2 Restriction of Use: The School of Medicine considers all PBL cases and supporting materials to be secure and intended solely for the educational purposes of the students and faculty of the University of Texas Medical Branch. Students should not access the PBL cases prior to release on the course website. At no time should the PBL cases and supporting materials be copied or distributed. Individuals violating these policies are subject to disciplinary action.

Student Presents Patient Subjective Patient Demographics PMH FH SH ROS Objective PE Labs

Student Presents Patient Assessment Primary problem Possible etiologies Relation among problems Rationale for interventions and diagnostic tests Plan Current medications Management steps

Learning Issues Discuss the learning issues and apply them to the case. Revise or reprioritize the Hypotheses List (if necessary) based on information ascertained from the discussion.

STOP and discuss before advancing slide. Diagnosis This slide includes: A diagnosis given to the patient and the patient’s reaction/questions. Tasks that should prompt the students to answer any patient questions and to justify the diagnosis given by providing the confirming evidence for the diagnosis or the disconfirming evidence for competing diagnoses. STOP and discuss before advancing slide.

STOP and discuss before advancing slide. Treatment Depending on the case, this may take the form of a description of treatment undertaken or a description of treatment options presented to the patient. This may take multiple slides and include patient questions about treatment. STOP and discuss before advancing slide.

Tasks Tasks at this point should include the impact of treatment - medically, psychologically and socially. Such as: Describe the effect of treatment(s) on problems. Describe other effects (possibly unintended) of treatment. Compare cost associated with treatment options. Discuss adherence issues for treatment regimen or recovery time if treatment is surgical. Discuss the above tasks (if not already discussed) before proceeding to next slide.

Please turn off projector using the wall-mounted key pad. Thank you. End Day 2 Please turn off projector using the wall-mounted key pad. Thank you.

Case Name & Day Begin Day 3 Restriction of Use: The School of Medicine considers all PBL cases and supporting materials to be secure and intended solely for the educational purposes of the students and faculty of the University of Texas Medical Branch. Students should not access the PBL cases prior to release on the course website. At no time should the PBL cases and supporting materials be copied or distributed. Individuals violating these policies are subject to disciplinary action.

Student Presents Patient Subjective Patient Demographics PMH FH SH ROS Objective PE Labs

Student Presents Patient Assessment Primary problem Possible etiologies Relation among problems Rationale for interventions and diagnostic tests Plan Current medications Management steps

Learning Issues Discuss the learning issues and apply them to the case. Revise or reprioritize the Hypotheses List (if necessary) based on information ascertained from the discussion.

Patient Follow-Up This slide includes: Follow-up visit including unresolved problems Follow-up lab values where appropriate Discuss before advancing slide. If new or unresolved problems are present, you may want to go back through the PBL Process.

Synthesizing Tasks This slide may include: Learning activities, e.g., quizzes, concept maps, etc Are there tasks such as diagrams etc that would help students synthesize the information in this case? Also consider alternate ending scenarios of how might this outcome be different : if the patient were older or younger? had chosen a different treatment option had a concurrent diagnosis of . . ., etc.

Theme Issues / Tasks This slide may include: Tasks focused on issues about health care delivery, preventive health, or professionalism that students should consider in reflecting on the case.

Credits Case author(s): Image attribution:

Please turn off projector using the wall-mounted key pad. Thank you. End Day 3 Please turn off projector using the wall-mounted key pad. Thank you.