Executive Solution Overview
3 references **files (1)** – ## CASESTUDY2.docx **## CASESTUDY2.docx** **CASE STUDY 2 – Chest Pain and Dyspnea: Diagnostic Reasoning in Primary Care** **Case Scenario** Ms. L.T. is a **61-year-old female** presenting with intermittent chest tightness and exertional dyspnea for 3 weeks. **History:** …
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3 references
**files (1)**
– ## CASESTUDY2.docx
**## CASESTUDY2.docx**
**CASE STUDY 2 – Chest Pain and Dyspnea: Diagnostic Reasoning in Primary Care**
**Case Scenario**
Ms. L.T. is a
**61-year-old female** presenting with intermittent chest tightness and exertional dyspnea for 3 weeks.
**History:**
· PMH: Hypertension, tobacco use (30 pack-years), anxiety
· Medications: Amlodipine 5 mg daily
· Symptoms: Chest discomfort radiating to jaw, relieved by rest
**Vitals:**
· BP: 156/88 mmHg
· HR: 96 bpm
**Initial Findings:**
· EKG: Nonspecific ST-T changes
· SpO₂: 95% on room air
**Student Assignment Requirements**
**1. Pathophysiology (25%)**
· Compare and contrast ischemic vs non-ischemic chest pain mechanisms
· Explain cardiopulmonary causes of dyspnea
· Address anxiety overlap
**2. Assessment & Differential Diagnosis (35%)**
· Focused cardiac and pulmonary exam
· Prioritized differential diagnosis
· Identification of
**life-threatening conditions**
· Decision-making for ED referral vs outpatient management
**3. Pharmacology & Initial Management (30%)**
· Acute and chronic pharmacologic considerations
· Antihypertensive optimization
· Risk reduction strategies
· Follow-up testing and referrals
**4. APA & Evidence Integration (10%)**
**RUBRIC – CASE STUDY 2 – Chest Pain and Dyspnea Diagnostic Reasoning (100 Points)**
**1. Pathophysiology of Symptoms (25 points)**
| | |
| — | — |
| **Level** | **Description** |
| **Excellent (23–25)** | Clearly differentiates ischemic and non-ischemic mechanisms of chest pain and dyspnea, accurately linking physiology to patient presentation. |
| **Satisfactory (18–22)** | Correct explanation of major mechanisms with limited depth or integration. |
| **Unsatisfactory (13–17)** | Partial or unclear explanation of pathophysiology. |
| **Poor (1–12)** | Incorrect or superficial explanation of mechanisms. |
| **Not Submitted (0)** | Section not submitted or missing. |
**2. Assessment & Differential Diagnosis (35 points)**
| | |
| — | — |
| **Level** | **Description** |
| **Excellent (33–35)** | Thorough, prioritized differential diagnosis with clear identification of life-threatening conditions and appropriate disposition decisions. |
| **Satisfactory (26–32)** | Appropriate differential but limited prioritization or incomplete reasoning. |
| **Unsatisfactory (18–25)** | Incomplete or poorly prioritized differential diagnosis. |
| **Poor (1–17)** | Unsafe or inaccurate diagnostic reasoning. |
| **Not Submitted (0)** | Section not submitted or missing. |
**3. Pharmacology & Initial Management Plan (30 points)**
| | |
| — | — |
| **Level** | **Description** |
| **Excellent (28–30)** | Evidence-based management addressing acute and chronic needs with clear rationale and follow-up. |
| **Satisfactory (22–27)** | Management plan is appropriate but lacks detail or optimization. |
| **Unsatisfactory (16–21)** | Partial or unsupported management decisions. |
| **Poor (1–15)** | Unsafe or inappropriate treatment plan. |
| **Not Submitted (0)** | Section not submitted or missing. |
**4. APA & Evidence Use (10 points)**
_(Same descriptors as Case 1)_
**## CASESTUDY2.docx**
**CASE STUDY 2 – Chest Pain and Dyspnea: Diagnostic Reasoning in Primary Care**
**Case Scenario**
Ms. L.T. is a
**61-year-old female** presenting with intermittent chest tightness and exertional dyspnea for 3 weeks.
**History:**
· PMH: Hypertension, tobacco use (30 pack-years), anxiety
· Medications: Amlodipine 5 mg daily
· Symptoms: Chest discomfort radiating to jaw, relieved by rest
**Vitals:**
· BP: 156/88 mmHg
· HR: 96 bpm
**Initial Findings:**
· EKG: Nonspecific ST-T changes
· SpO₂: 95% on room air
**Student Assignment Requirements**
**1. Pathophysiology (25%)**
· Compare and contrast ischemic vs non-ischemic chest pain mechanisms
· Explain cardiopulmonary causes of dyspnea
· Address anxiety overlap
**2. Assessment & Differential Diagnosis (35%)**
· Focused cardiac and pulmonary exam
· Prioritized differential diagnosis
· Identification of
**life-threatening conditions**
· Decision-making for ED referral vs outpatient management
**3. Pharmacology & Initial Management (30%)**
· Acute and chronic pharmacologic considerations
· Antihypertensive optimization
· Risk reduction strategies
· Follow-up testing and referrals
**4. APA & Evidence Integration (10%)**
**RUBRIC – CASE STUDY 2 – Chest Pain and Dyspnea Diagnostic Reasoning (100 Points)**
**1. Pathophysiology of Symptoms (25 points)**
| | |
| — | — |
| **Level** | **Description** |
| **Excellent (23–25)** | Clearly differentiates ischemic and non-ischemic mechanisms of chest pain and dyspnea, accurately linking physiology to patient presentation. |
| **Satisfactory (18–22)** | Correct explanation of major mechanisms with limited depth or integration. |
| **Unsatisfactory (13–17)** | Partial or unclear explanation of pathophysiology. |
| **Poor (1–12)** | Incorrect or superficial explanation of mechanisms. |
| **Not Submitted (0)** | Section not submitted or missing. |
**2. Assessment & Differential Diagnosis (35 points)**
| | |
| — | — |
| **Level** | **Description** |
| **Excellent (33–35)** | Thorough, prioritized differential diagnosis with clear identification of life-threatening conditions and appropriate disposition decisions. |
| **Satisfactory (26–32)** | Appropriate differential but limited prioritization or incomplete reasoning. |
| **Unsatisfactory (18–25)** | Incomplete or poorly prioritized differential diagnosis. |
| **Poor (1–17)** | Unsafe or inaccurate diagnostic reasoning. |
| **Not Submitted (0)** | Section not submitted or missing. |
**3. Pharmacology & Initial Management Plan (30 points)**
| | |
| — | — |
| **Level** | **Description** |
| **Excellent (28–30)** | Evidence-based management addressing acute and chronic needs with clear rationale and follow-up. |
| **Satisfactory (22–27)** | Management plan is appropriate but lacks detail or optimization. |
| **Unsatisfactory (16–21)** | Partial or unsupported management decisions. |
| **Poor (1–15)** | Unsafe or inappropriate treatment plan. |
| **Not Submitted (0)** | Section not submitted or missing. |
**4. APA & Evidence Use (10 points)**
_(Same descriptors as Case 1)_