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NS121 Human Biology: Selected Topics in Medicine

Suggested Outline for Anna Charles report

A report for a case of this complexity would typically be 7-9 pages including a bibliography page. You'll see by reading through this, that if you take good notes while you're working on the case, you'll just have to "paste" them together and smooth out the organization in order to write the report.

Use as an outline, all the information you entered on your analysis sheets, and develop each item with some background information and explanation.

I. Summary paragraph that states the team's conclusion about the diagnosis of Anna Charles. (In the example below, the team was left with 3 possibilities, but one was thought to be most likely. Your team may have come out differently on this, but you'd support that conclusion in the rest of the report as you'll see.)

"We believe that the most likely explanation of the bruising that appears as macular purpura on Ms. Charles' arms and legs are not indications of life threatening disease. We narrowed down on three possible causes: normal effects of aging on fine blood vessels (senile purpura); effects of sun exposure (solar purpura); and side effects of medication (Neurontin)."

II. Process by which we decided on this diagnosis (Differential Diagnosis).

a. Summary of initial information. This is a summary of what you learned. Don't just copy over what is on the page we handed you.

"Ms. Charles is a 66 year old retired woman who came with complaints of bruises on her arms and legs that she doesn't recall having resulted from trauma. She has had periods of insomnia and currently complains of joint and back pain. Her knee replacement of a year ago has not given her relief of pain in that leg, nor has it improved mobility. She is seeing the osteopathic surgeon who performed that surgery, and x-rays do not reveal a mechancial source of that pain. She currently is taking Mobic and Neurontin. She appears in good spirits other than distress at the pain and bruising, and her vital signs are normal."

b. List of initial diagnoses. On the basis information we received at our initial meeting with Ms. Charles, we considered the following possible causes of the bruising.

--Anemia (because bruising may have indicated something wrong with her blood; what are symptoms of anemia? how do you test for it?).
--Melanoma (perhaps from sun exposure? need to look up what those skin lesions look like and what purpuric lesions look like)
--Side effects of medication (need to find out more about meds she is using)
--Dietary (nutritional) deficiency (maybe one that affects blood clotting; need to know more about her diet)
--Food allergy (has she ever had allergies to food?what are food allergy symptoms like? any particular foods we could tell her tend to cause rashes?)
--Rash from overexposure to sun (find about more about symptoms of sun rash; ask HB about frequency of sun exposure)
--Memory loss (senile dementia or Alzheimers? has she had memory problems? family history?)

c. What your team learned in their first set of assignments. In reading further about the definitions of purpura, ecchymoses, and the drugs, we added a few other possiblities to our list. (Show additional ideas you developed about diagnoses and also tell what you learned in looking up terms or learning about some of the diagnoses that didn't pan out--you did a lot of work to find that out, so tell us what you learned.)

--Senile purpura because...(here you could tell what purpuritic lesions are and what diseases or conditions they might be associated with)
--Cushing's disease because...(tell something you learned about Cushing's disease. Maybe someone in your group learned a lot about it. Learn as much as you can and ask questions about anything you don't understand).
--Some kind of clotting disease that might have to do with low platelet levels... (ditto comment above; tell us about any diseases you learned about).

d. How you eliminated some of those diagnoses. (Here is where you tell us what you learned and how you found the information.)

EXPLAINING YOUR RATIONALE FOR ELIMINATING CERTAIN DIAGNOSES IS THE MOST IMPORTANT PART OF THE CASE REPORT AND YOU SHOULD BE MOST DETAILED IN THIS SECTION (AND USE CITATIONS TO SHOW WHERE YOU GOT YOUR INFO).

For instance, when you wrote about anemia, you would tell us

  • what you learned about anemia and
  • what tests you asked for to see if she has anemia and
  • what her results were (give actual numbers) and
  • what you conclude from that.

Include references to the books or web sites you used to learn about anemia (Harrison's, 2001), about which blood tests to use for anemia (Fischbach, 1999), and the actual numbers you saw on Ms. Charles' blood test results (what is normal and what were hers--use units).

III. Summary of your final diagnosis and how you reached it.

So for Ms. Charles you might talk about all three possibilities and which you think most likely and why.

IV. Recommendations.

You might suggest that Ms. Charles limit her sun exposure to early morning or late afternoon and to use sun block on her arms and legs all day. Some of you also thought you might ask her to decrease her dosage of Neurontin because of possible side effects (that you will tell about and give references to how you know that).

What will you ask about, look for, or test for in her 6 month follow-up exam?

V. Bibliography

Include here a complete listing of all resources you used (books, webs, journals, people) with the complete citation.

(The pain and sleep aspects aren't emphasized in this outline, but that's just because this is just a sample section of a whole report.
You would bring in all the other informaion as it fits your rationale.)

Your reports may all differ in the sense that you'll probably write more about sections that you did the research on and learned more about than others in your group. We expect that, and it's the way you have of showing us how much you did and what you learned as well as a way to ask us about parts that you didn't quite understand and would like to have some clarification.

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