Clinical Problem Solving: Decreased Level of Consciousness and Unexplained Hydrocephalus

We present a clinical reasoning case of 42-year-old male with a history of type 1 diabetes who presented to hospital with decreased level of consciousness. We review the approach to coma including initial approach to differential diagnosis and investigations. After refining the diagnostic options based on initial investigations, we review the clinical decision-making process with a focus on narrowing the differential diagnosis, further investigations, and treatment.

Increasing Team Effectiveness Through Experiential Team Training: An Explanatory Mixed-Methods Study of First-Year Veterinary Students’ Team Experiences

This article explores the impact of experiential team communication training on student team effectiveness. First-year veterinary students were concurrently enrolled in the Group Communication in Veterinary Medicine course and applied their knowledge to their authentic team experiences in the Veterinary Anatomy and Introduction to Clinical Problem Solving courses. All students completed a modified team effectiveness instrument and a team self-reflection at the end of the semester. Results show that students experienced a high level of team effectiveness. Although students experienced challenges with respect to staying on task and distributing roles and responsibilities, team coordination and communication improved over time, due in part to the team activities associated with the team training intervention. This research provides support for the impact of experiential team training to the development of team process skills and team effectiveness.

Problem-solving with clinical reasoning: A case report of coronavirus in immunosuppressive condition

Background: One of the most interesting parts of medical science is using clinical reasoning to solve clinical problems. In today’s world of medicine, with increasing amounts of scientific information and new diagnostic and treatment facilities, physicians’ responsibility in managing the condition of patients becomes weightier. Making the correct decision is an important goal that can be achieved by having adequate information and using it appropriately. At this stage, we should follow the thought process of successful doctors and use information from books and articles to solve clinical problems. The purpose of this article is to improve the skills of physicians in the effective use of knowledge and experience to solve clinical problems to increase our success in fulfilling our responsibility to patients. Methods: Clinical reasoning enhances the quality of learning and increases the ability of medical students in clinical problem-solving. In this article, a patient with rheumatoid arthritis in the COVID-19 pandemic developed respiratory distress, is identified by the clinical reasoning method and is treated, with his treatment then discussed. This article includes the following: prepare a list of differential diagnoses based on the list of signs and symptoms of the patient; modify the initial list to reflect findings from history and examinations; specify additional information to make a correct diagnosis; and, finally, decide when the information is obtained is sufficient to make the proper diagnosis. Results: In recent years, clinical reasoning has received more attention in student Olympiad competitions. Professors in medical sciences should pay special attention to teaching this skill to students. It is necessary to plan for teaching this type of training and to design tests for evaluating students’ clinical reasoning. This article can thus be a useful guide for those who enjoy working on a problem to get an answer. Conclusion: This article shows how insidious and life-threatening a coronavirus infection can be, and how useful clinical reasoning can be when present in all stages of dealing with the patient, from the initial stages of taking the patient history to the end of treatment.

Distinguishing Spastic and Dystonic Features in a Patient With a History of Brainstem Encephalitis: A Clinical Case Study

Purpose One role of a speech-language pathologist (SLP) is to differentially diagnose motor speech disorders to aid physicians, typically neurologists, in establishing a medical diagnosis. The present case study describes the clinical problem solving undertaken by the SLP to characterize the nature of neurological deficits to develop an appropriate management plan. Method The patient is a 29-year-old man with a history of brainstem encephalitis who presented for evaluation of dysarthria, dysphagia, and gait difficulties. The neurological exam characterized a spastic dysarthria. The SLP conducted a motor speech examination expressly for the purpose of differential diagnosis. Results The patient exhibited features of spastic dysarthria including strained phonation and hypernasality, equivocally slow rate associated with intermittent interword pauses rather than lengthened segments, and articulatory imprecision in the absence of weakness or slowness of the articulators. Defining features of spastic dysarthria absent from his speech were monopitch and monoloudness, as well as slow alternate motion rates. A diagnosis of hyperkinetic dysarthria associated with dystonia was informed by (a) hypernasality disproportionate to other deviant speech features, with preserved reflexive velar movements and nonspeech movements; (b) adventitious lip pursing; (c) modest improvement in speech with sensory tricks; (d) mild and intermittent phonatory strain; and (e) normal nonspeech oral motor function. Conclusions This case demonstrates the role speech-language pathology can play in the neurological assessment and management process. The recognition by the SLP of hyperkinetic dysarthria led to additional diagnostic tests and to a broader range of options for medical management.

Clinical Problem-Solving: Lower Extremity Weakness & Paresthesia in an Immunocompromised Patient With a Complex Cancer History

We present a case of new onset bilateral lower extremity weakness, paresthesia, urinary retention and bowel incontinence in a 51-year-old man. He had a complicated history of acute myelogenous leukemia with known central nervous system (CNS) and leptomeningeal involvement status post allogenic stem cell transplant complicated by chronic graft versus host disease (GVHD). We review the differential diagnosis as the physical exam and diagnostic results evolved. We also provide a review of the relevant literature supporting our favored diagnosis, as well as other competing diagnoses in this complicated case. The ultimate differential diagnosis included viral myelitis, treatment-related myelopathies, and CNS GVHD. The case provides a sobering reminder that even with an appropriate diagnostic workup, some cases remain refractory to therapeutic efforts. It also underscores the importance of a sensitive neurologic exam, given the significant clinico-radiological delay, and reviews the complex differential diagnosis for myelopathy.

Clinical Problem Solving: An Older Woman With Weakness from Head to Toe

A 67-year-old woman was admitted to our hospital for progressive weakness, dysphagia, muscle pain, and weight loss. Here we detail the clinical problem solving involved in diagnosing and treating her immune-mediated necrotizing myopathy caused by anti-HMGCoA reductase autoantibodies. Interestingly, this diagnosis coincided with discovery of a gastrointestinal stromal tumor (GIST) and positivity for anti-nuclear matrix protein (anti-NXP2), another myositis specific autoantibody.

Dysphagia and Considerations for Nutritional Intervention

This chapter discusses a clinical case from the interdisciplinary practice of dysphagia and the collaboration between speech-language pathology clinicians and dietetics professionals from the perspective of the speech-language pathologist. The discussion begins with an introduction to the normal swallowing process to better understand disordered swallowing and the role of therapeutic and compensatory interventions. Changes in swallowing that occur with normal aging and their impact are identified and reviewed. Common interventions and considerations in the clinical management of dysphagia from the perspective of the speech-language pathologist are included with rationale based on the current literature. Swallowing motor functions and factors in dysphagia decision making are discussed in relationship to clinical problem solving with a sample case and nutritional interventions. The chapter closes with general recommendations and conclusions to assist in learning and understanding of the concepts discussed.