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
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
mechanisms of chest pain and dyspnea, accurately linking physiology to
patient presentation. |
|
Satisfactory (18–22) |
Correct explanation of major mechanisms with limited
depth or integration. |
|
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
clear identification of life-threatening conditions and appropriate
disposition decisions. |
|
Satisfactory (26–32) |
Appropriate differential but limited prioritization
or incomplete reasoning. |
|
Unsatisfactory (18–25) |
Incomplete or poorly prioritized differential
diagnosis. |
|
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
chronic needs with clear rationale and follow-up. |
|
Satisfactory (22–27) |
Management plan is appropriate but lacks detail or
optimization. |
|
Unsatisfactory (16–21) |
Partial or unsupported management decisions. |
|
Poor (1–15) |
Unsafe or inappropriate treatment plan. |
|
Not Submitted (0) |
Section not submitted or missing. |
