Part I—The Initial Physical Examination

Scenario

Mary and Bill adopted a three-year-old toddler named Sam two weeks ago. Sam is good-natured and very inquisitive. Typically, before the finalization of an adoption, children are required to undergo a routine examination by a physician. However, the required examination is not meant to be a complete health screening, and many conditions are not even checked. Therefore, Mary and Bill are bringing Sam to Trinity Medical Center for a standard physical examination by a pediatrician to assess his health status.

Patient History

Very little information was known about Sam’s parents. However, it was known that they died in an automobile accident when Sam’s father suffered a massive heart attack. In the past two weeks Sam has done very well adjusting to his new environment. Moreover, he has had all the proper immunizations for his age.

Sam’s adoptive parents, Mary and Bill, have noticed some greasy/oily stools in his diaper. In addition, they are concerned about his wheezing (when breathing).

Physical Examination

Vital Signs

• Age: 3 yrs., 1 month
• Weight: 28 lbs. (lower 10%-tile)
• Height: 3 ft. 1 inch
• Pulse: 115 beats/minute
• Respirations: 30 breaths/minute
• Blood Pressure: 95/60 (systolic/diastolic) mmHg

General Appearance

• Happy, energetic child

Head and Neck

• Runny nose but his ears are clear of fluid

Lungs

• Cracking sounds are present
• Coughing and wheezing are noticeable

Cardiovascular

• Normal

Abdominal

• No swelling is present

Genitourinary

• Not assessed

Extremities

• Full mobility is present
• Pulse found in arms and legs

Neurological

• Normal reflexes

Physician Comments

Have a complete blood count and chest x-ray done. Also, schedule a follow-up appointment for tomorrow to review the lab results and chest x-ray.

Objectives for PBL group

1. Assign people positions/roles for the case study such as group leader, typist, secretary, and editor.
2. Brainstorm on what you (a) know about the case, and (b) do not know, but would like to know about the case.
3. Formulate your initial ideas (or hypotheses) about what is wrong with Sam.
4. Identify and define terms and concepts you do not understand.
5. Write an approximately one-page group report that includes (a) the roles each person is assigned to, (b) your initial hypothesis and the evidence that led to its formulation, and (c) the terms and concepts that were initially identified as being unknown to you. Make sure you properly cite the source when explaining a concept.
6. You will be given Part II upon completion of Part I.

Date Posted: 02/20/05 nas

Image Credit: Lucius Osgood, Osgood’s American First Reader for Schools and Families (Pittsburgh: H. I. Gourley, 1870). Provided courtesy of The Florida Center for Instructional Technology (FCIT).

Copyright © 1999–2010 by the National Center for Case Study Teaching in Science.  Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

---