PBL Sessions: Immunologic Diseases

Page 1

Introduction:

Your medical practice includes the thrifty Wolstenholme family:

Family History:

Jack is an electrician without a permanent job, doing subcontracting work for various home builders. Madge has a part time job with the school district as a teacher's aide. They have been married for the past 9 years. James is in high school and is the son of Jack by a former marriage. Sarah attends a local elementary school. The family lives in a recreational vehicle, which is all they have left after a hurricane destroyed their house. The RV is parked mostly in the driveway of friends they have, until someone gets tired of having a big RV blocking the driveway, or too many people using the bathroom, because the RV's holding tank gets full fast if there is no convenient sewer connection. Heather lives and works at an equestrian stable. No one in the family has health insurance.

History of Present Illness:

The son, James, is now living with the family after spending half the year with his step-mother. He has noted a rash that has appeared on his hands and forearms over the past day.

The daughter, Sarah, has had episodes of marked facial and extremity swelling without itching or hives for the past year. Each episode occurs 4 to 12 weeks weeks apart and resolves in 1 to 3 days. Some of these episodes have been accompanied by abdominal pain with watery diarrhea.

Tasks

• What problems can you identify?

• What hypotheses can you suggest that might be causing problems for these family members?

• 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.