1. Define the following terms: (Angina, Radiation, Apical Heart rate, S2, S4, R2ICS, Apex, Indirect Hernia) Answer
2. Cite the primary clinical problem (not the diagnosis) Answer
3. Develop a general differential diagnosis of this clinical problem using categories of disease. Cite examples from each: Answer
4. In general, what factors (data) would you take into consideration when determine a differential diagnosis of specific diagnosis: Answer
5. Develop a specific differential diagnosis (higher probability causes of chest pain in this patient). Answer
6. What is your diagnosis: Why? Answer
7. Describe the Coronary arterial system. Answer
8. How is blood flow (oxygen supply) to myocardium regulated and accomplished? Answer
9. What is the patho-physiology of Myocardial ischemia? Answer
10. What are the risk factors for this disease in this patient? Answer
11.What is the significance of determining levels of low density (LDL) and high density (HDL) lipoproteins in a patient with increased cholesterol ? Answer
We are now ready for a diagnostic strategy
The development of a diagnostic strategy depends on the characteristics of the diagnostic tools that are used and the characteristics of the patient. The history, physical, laboratory studies, and supplemental tests all provide information that may enable the physician to reach a diagnosis. The operating characteristics of historical data, data from the physical exam, and further testing are described by the terms sensitivity, specificity, positive value, negative predictive value, and positive and negative likelihood ratio.
12. Define these terms Answer
13. In considering Mr. Solomon’s presentation with "pain on my chest" what are the key parts of the history and physical that influence how you develop a differential diagnosis? Qualitatively, what is your impression of the sensitivity and specificity of the historical and physical exam findings? Answer
14 What are the options available for us to make a diagnosis of Angina? Answer
15. What supplemental testing, if any, would you want in addition to the history, physical, and laboratory studies that are listed? Answer
16. The characteristics of a patient determine how one interprets data obtained from that person. For example, a positive HIV test on a cloistered nun who has never had any sexual contact, blood exposure or other risk is almost certainly a false positive. In Mr. Solomon’s case, what characteristics, or risk factors, make you think it is likely that he has the diagnosis you consider most likely. Given these characteristics, is there any point in supplemental diagnostic testing for Mr. Solomon? Would you believe a negative or positive test? Should be proceed directly to the "gold standard"?. Answer
17. What drug therapy would you consider prescribing to control his symptoms? Answer
18. What would you consider to modify Mr. Solomon’s risk factors ? Answer
19. What drug therapy would you consider to prevent further progression of obstruction to Coronary arteries ? Answer
20. What options do we have to relieve mechanical obstruction of Coronary arteries ? Answer