1. Step 1
1.1. Identify terms and cues
1.2. new terms
1.2.1. tinge
1.2.1.1. discoloration
1.2.2. weary
1.2.2.1. tired/fatigue
1.2.3. armoured
1.3. cues
1.3.1. obese man in 50s
1.3.2. breathless
1.3.3. admitted to ED by wife
1.3.4. weary
1.3.5. confused since the last few days
1.3.6. swollen ankles for 2 to 3 months and got more breathless with weight gain
1.3.7. off work for 2 weeks due to sleepiness
1.3.8. loud snorer with episodes of breathlesness
1.3.9. got cold 4 days ago with sputum
1.3.10. increasing sleeping problem over the last 10 years
1.3.11. bluish tinge to his lips and fingers
1.3.12. armored vehicle during daytime job
1.4. 10 minutes
2. Step 4
2.1. Hypothesis organization (tentative solution)
2.1.1. acute over chronic
2.1.2. chronic
2.1.2.1. obstructive sleep apnea
2.1.2.1.1. can be increased bu drug abuse
2.1.2.1.2. alcohol before sleep
2.1.2.1.3. copd
2.1.2.2. right-side heart failure
2.1.2.3. restrictive lung dis due to obesity
2.1.2.4. central sleep apnea
2.1.3. acute
2.1.3.1. respiratory tract infection explaining weary, cough and confution
2.2. 20 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. sleep apnea disorders
3.1.1.1. obesity?
3.1.1.2. other disorders that might cause these symptoms
3.1.1.3. relative antomy
3.1.2. sleep physiology
3.1.3. hypoxia and confusion
3.2. 10 minutes
4. Step 2
4.1. Problem formulation (put it in a senates)
4.1.1. obese man in his 50s presented to ED with breathlesness, confusion, fatigue and swollen ankles along with caynosis and 4-day history of cold associated with sputum. Have been absent from work for the last 2 weeks due to increasing sleepines during daytime.
4.2. 10 minutes
5. Step 3
5.1. Hypothesis generation (brainstorming)
5.1.1. breathlesness
5.1.1.1. might indicate obstruction in upper or lower airway, heyperresponsivness (type 1 hr)
5.1.1.2. can cause sleepiness in daytime
5.1.1.3. upper airway narrowing
5.1.1.4. heart failure
5.1.1.5. airway problem or in parenchyma (fibrosis)
5.1.1.6. ressisntence increased in pulmonary vessels (pul. hypertention)
5.1.1.7. obesity causing chest expantion restriction
5.1.2. cyanosis
5.1.2.1. not enough o2 perfusion or saturation (cardiac or pulmonay or hematologic)
5.1.2.2. central and periphral
5.1.3. swollen ankles
5.1.3.1. hypoxia leading to hypoxic kidney reducing excretion of fluids
5.1.3.2. right side HF, liver or kidney failure
5.1.3.3. increased in pressure will cause fliud leakage
5.1.3.4. causing weight gain
5.1.4. sleeping/fatigue
5.1.4.1. total breathlesness due to snoring from obstruction or obesity
5.1.4.2. realaxed mm leading to narroed airway
5.1.4.3. complete airway blockage can cause apnea
5.1.4.4. hypoxemia
5.1.4.5. drugs consumption
5.1.4.6. diphragm elevation reducing inspiration (snoring)
5.1.4.7. mainly in upper airway
5.1.5. confusion
5.1.5.1. drug/alcohol effect
5.1.5.2. not enough sleep
5.1.5.3. hypoxia
5.1.5.4. cns problem??
5.1.6. cold, cough and sputum
5.1.6.1. upper resp infetion
5.1.6.2. acute on top of chronic (sputum analysis)
5.1.6.3. part of disease progresion