1. Step 6
1.1. Review session 1
1.1.1. Summary of step 5
1.1.1.1. Step 5
1.1.1.1.1. Formulate learning objectives
1.2. Report new knowledge
1.2.1. Anatomy
1.2.1.1. genral
1.2.1.2. lung
1.2.2. Pathophysiology
1.2.2.1. cough reflex
1.2.2.1.1. http://www.youtube.com/watch?v=2hrcH240SgQ
1.2.2.2. night sweat
1.2.2.2.1. pathological ondition
1.2.2.3. phlegm
1.2.2.3.1. immune response
1.2.2.4. weight loss
1.2.2.4.1. derease appetite
1.2.2.4.2. does iron deficincy in TB patient help in treating bacteria in comparison to sufficient iron level ?
1.2.2.5. bloody phlegm
1.2.2.5.1. due to irritation
1.2.2.5.2. indication
1.2.2.6. what is the difference between cystic fibrosis and pulmonary fibrosis?
1.2.2.6.1. cycstic child disease
1.2.3. Patholog
1.2.3.1. TB
1.2.3.1.1. night sweat, weight loss, bloody phlegm, fatique
1.2.3.2. pnuemonia
1.2.3.2.1. no night sweat
1.2.3.3. lung cancer
1.3. 30 minutes
2. Step 8
2.1. Diagnostic decision
2.1.1. mycobacterum tuberculosis infection
2.2. Mechanism
2.2.1. the bacteria enters the body
2.2.2. activate the macrophage
2.2.3. then activated the T cell helper 1 which eventually cause caseous necrosis
2.3. Presentation
2.3.1. cough with phlegm and blood
2.3.2. night sweat
2.3.3. weight loss
2.3.4. fatique
2.4. Supporting data
2.4.1. X-ray
2.4.1.1. marked plural thickening in right upper lobe (consolidation)
2.4.2. sputum
2.4.2.1. acid fast bacilli positive three times
2.4.2.2. mycobacteria identify
2.4.3. PPD
2.4.3.1. 16 high
2.5. 10 minutes
2.6. PICO
2.6.1. in middle age TB patient is methacilin better for the treatment of Tb rather than rifampicine?
2.6.2. in middle age TB pateint does amoxiciline help in decrease the mycobacteria in comparision to no treatment
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. history
3.1.1.1. risk factors?
3.1.1.1.1. smokeing
3.1.1.1.2. diabetes
3.1.1.1.3. HIV or sexually active
3.1.1.1.4. exposed to chemical
3.1.1.2. history of present illness
3.1.1.2.1. no pain
3.1.1.2.2. no shortness of breath
3.1.1.2.3. sever cough
3.1.1.2.4. yellowish sputum and blood
3.1.1.2.5. extremely tired
3.1.1.2.6. low appetite
3.1.1.3. past history
3.1.1.3.1. no HIV
3.1.1.3.2. not vaccine
3.1.1.3.3. no syrgeries
3.1.1.3.4. no hypertension
3.1.1.3.5. exposed to patient
3.1.1.3.6. nodiabetes
3.1.1.4. family history
3.1.1.4.1. no signifacnt family history
3.1.1.4.2. crowded house
3.1.1.5. social
3.1.1.5.1. no smoking
3.1.1.5.2. not alcoholic
3.1.1.5.3. stopped his activities
3.1.2. examination
3.1.2.1. hand
3.1.2.1.1. no clupping
3.1.2.2. no lymph node evlargment
3.1.2.3. no liver or spleen enlargement
3.1.2.4. plural expansion normal
3.1.2.5. percussion : reasoning
3.1.3. tests results
3.1.3.1. X-ray
3.1.3.1.1. marked plural thickening in right upper lobe (consolidation)
3.1.3.2. sputum
3.1.3.2.1. acid fast bacilli positive three times
3.1.3.2.2. mycobacteria identify
3.1.3.3. CBC
3.1.3.3.1. lymphopnea
3.1.3.3.2. mild anemia
3.1.3.3.3. esr high
3.1.3.4. sensitivity : mycobacterial TB sensitive to: INH, rifampin, and ethambutol
3.1.3.5. PPD
3.1.3.5.1. 16 high