A Typical Cold? by Brent J.F. Hill

Part II—The Follow-up Visit

Scenario

Today is Sam’s follow-up medical appointment. The weather is very hot and humid, which makes it almost unbearable to be outside. Sam’s parents parked their car in the parking lot of Trinity Medical Center and went into the air-conditioned comfort of the pediatric clinic.

They were immediately seen by the pediatrician, and Mary expressed her concern over the color of Sam’s sputum. Mary was upset that she had forgotten to tell the pediatrician the other day about this fact. The sputum Sam had been coughing up was green and viscid.

While talking with Mary and Bill about Sam’s sputum, the pediatrician looked over at Sam and noticed a white “frosting” on his face (the “frosting” is an indication of salty build-up on the drying edge of sweat). The pediatrician asked Mary and Bill if they had noticed this salty build-up before.

“That must be why his skin tastes a bit salty when I kiss him on his check,” Mary replied.

The pediatrician then went over the blood count and chest x-ray results (described below) with Mary and Bill.

After describing the chest x-ray results to them, the pediatrician had a hypothesis about Sam’s chest x-ray results. To test her hypothesis the pediatrician ordered a sweat chloride test (the result is listed below).

Blood Lab Results

• White blood cell count: values within normal limits.
• White blood cell differential: lymphocytes, monocytes, eosinophils, and basophils are within normal limits. There is a slight elevation in neutrophils.
• Red blood cell count: values within normal limits
• Hematocrit: values within normal limits
• Platelet count: values within normal limits

Chest x-ray Results

• Some hyperinflation and bronchial wall thickening is apparent.

Sweat Chloride Test Results

• Indeterminate

Objectives for Your PBL Group Session

1. Identify the most important concepts (“learning issues”) from both Part I and Part II that you need to investigate to diagnosis the causes for Sam’s symptoms.
2. Divide up the “learning issues” for each group member to investigate.
3. The group leader will need to turn in a list of your “learning issues” which identifies by name the group member assigned to each one.

Part II Individual Report

1. Define terms and concepts you don’t understand while investigating your “learning issue.”
2. Thoroughly explain your “learning issue.”
3. Do you have a different hypothesis about the case after investigating your “learning issue”? Provide the reasons or evidence for the change in your thinking or for why you still consider your initial hypothesis to be the most valid one.
4. Cite all the sources you used. Make sure that you include in-text citations as well as a bibliography at the end of your report.

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