PBL Sessions: Hematology Organ System - 2


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Page 2

History of Present Illness:

Your physical examination shows vital signs with T 38.1 C, P 92/min, RR 18/min, and BP 115/70 mm Hg. She is alert and oriented and in mild distress, appearing anxious. Her skin is pale. Her heart rate is regular with no murmurs. Her lungs are clear to auscultation. Palpation of the abdomen reveals no masses or areas of tenderness, and active bowel sounds are present. You note the presence of a 7 cm long oblique well-healed scar in the right upper quadrant, and an 8 cm long well-healed transverse midline scar in the lower abdomen. The rectal examination reveals no masses, and the stool guaiac is negative. Pelvic examination is unremarkable. You obtain a Pap smear. Pulses in the extremities are 2+ bilaterally. Motor strength is not decreased. Reflexes are normal. Her right thigh is swollen, compared to the left, and pain is elicited upon raising the right leg. Cranial nerves II through XII are intact and there are no localizing neurologic signs. Funduscopic examination is unremarkable.

Tasks

  • What problems can you identify?

  • What hypotheses can you suggest that might be causing her problems?

  • Explain your reasoning for the hypotheses you choose.

  • What learning issues are being identified?

  • What additional information might you request?

Stop !! Complete discussions and tasks before moving to the next page.