PROBLEM-BASED LEARNING ON PATIENT MANAGEMENT
Patient with a Toothache
Discussion Guide for the Faculty/Student Facilitator
SESSION I
I. Pathophysiology, Clinical Diagnosis, Paraclinical Diagnosis, Treatment and Rehabilitation
PATHOPHYSIOLOGY
Trigger: A 10-year-old boy with toothache
Processing:
Is there a problem?
What is the problem?
What is the cause or pathophysiology of the problem?
Can you describe/explain the change from normal to abnormal state to bring about the symptom or sign?
Can you explain what causes the change?
What are the organs/tissues that may be possibly involved based on the limited data on hand?
What are diseases involving these organs/tissues that can may produce the symptom or sign in question?
Can you describe/explain the pathophysiology of these diseases?
Can you describe the syndrome (the usual manifestations) of these diseases?
CLINICAL DIAGNOSIS
Trigger: Symptomatology of the Patient
The toothache was noted 3 days ago. The pain was becoming more and more intolerable.
Processing:
What's your diagnosis based on the symptomatology?
Why?
What's your closest differential diagnosis?
Why?
Trigger: Signs of the Patient (Physical exam findings)
Examination of the mouth shows a cavity in the left lower 2nd molar.
Processing:
What's your diagnosis based on the signs?
Why?
What's your closest differential diagnosis?
Why?
What's your diagnosis based on the signs and symptoms?
Why?
What's your closest differential diagnosis?
Why?
PARACLINICAL DIAGNOSIS
Do you need a paraclinical diagnostic procedure?
Why?
If yes, what paraclinical diagnostic procedures can be done for this patient based on your clinical diagnosis?
Why?
Can you describe/explain the following issues on the various paraclinical diagnostic procedures that can possibly be done on the patient?
- How are the procedures being done
- What are the usefulness, benefits, and advantages
- What are the limitations, risks, and disadvantages
- Interpretation of results
Trigger: Suppose paraclinical diagnostic procedures were done.
An x-ray of the tooth was done. The x-ray showed a radiolucency at the root of the tooth.
Processing:
How do you interpret the results?
What is your diagnosis after the paraclinical diagnostic procedures were done?
Why?
What is your closest differential diagnosis?
Why?
Based on your diagnosis at this point in time, what treatment do you think should be done to the patient?
Why?
Can you describe/explain the following issues on the various treatment procedures that can possibly be done on the patient?
- How are the treatment procedures being done
- What are the usefulness, benefits, and advantages
- What are the limitations, risks, and disadvantages
- What are the rehabilitation programs that can be done after the treatment procedures
Trigger: The following treatment was done.
The left lower second molar was extracted.
What do you think will be the outcome of this treatment?
The following was the outcome.
The toothache eventually disappeared.
The boy now has no left lower second molar.
How do you now compare the treatment the patient received with the other possible
treatment options?
Do you think the patient will do better with the other treatment options?
What do you think the rehabilitation program for the patient will be after the treatment he has received?
Final set:
The patient did not receive any rehabilitation program.
Four years after the treatment, the patient showed no sign of recurrence of the
problem.
Final diagnosis was: radicular cyst of the left lower 2nd molar.
Output: Learning Issues
Next step: Independent Study
SESSION II
II. Pathophysiology, Clinical Diagnosis, Paraclinical Diagnosis, Treatment, Rehabilitation, and Other Issues and Aspects of the Patient Problem
Report of learning acquired during Independent Study.
Emphasis:
Diseases producing the symptom or sign in question; their syndrome or usual manifestations; their pathophysiology.
Refinements, if any, on the clinical diagnosis.
Answers and refinements on the following:
Do you need a paraclinical diagnostic procedure?
Why?
If yes, what paraclinical diagnostic procedures can be done for this patient based on your clinical diagnosis?
Why?
Can you describe/explain the following issues on the various paraclinical diagnostic procedures that can be possibly done on the patient?
- How are the procedures being done
- What are the usefulness, benefits, and advantages
- What are the limitations, risks, and disadvantages
- Interpretation of results
Based on your diagnosis at this point in time, what treatment do you think should be done to the patient?
Why?
Can you describe/explain the following issues on the various treatment procedures that can possibly be done on the patient?
- How are the treatment procedures being done
- What are the usefulness, benefits, and advantages
- What are the limitations, risks, and disadvantages
- What are the rehabilitation programs that can be done after the treatment procedures
Reflection on the patient management problem
- what other aspects of the problem do you like to tackle
- learning acquired
- problem-based learning activity
Additional topics for discussions or problem-based learning:
1. Population or community perspective of the patient health problem
2. Bioethical issues on the patient health problem
3. Medicolegal issues on the patient health problem
4. Psychosocial issues on the patient health problem
5. Research issues on the patient health problem
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