Advanced Primary Care of Family I-HBN-HY01 Luis Serrano
🩺 CASE STUDY 2 – Chest Pain and Dyspnea: Diagnostic Reasoning in Primary Care 5 pages
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 |
Satisfactory (18–22) | Correct explanation of major mechanisms with limited |
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 |
Satisfactory (26–32) | Appropriate differential but limited prioritization |
Unsatisfactory (18–25) | Incomplete or poorly prioritized differential |
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 |
Satisfactory (22–27) | Management plan is appropriate but lacks detail or |
Unsatisfactory (16–21) | Partial or unsupported management decisions. |
Poor (1–15) | Unsafe or inappropriate treatment plan. |
Not Submitted (0) | Section not submitted or missing. |
