1. Step 1
1.1. Identify terms and cues
1.2. New terms
1.2.1. self-employed
1.2.1.1. independant worker
1.3. cues
1.3.1. 56 y male
1.3.2. self employed builder
1.3.3. wants a general check-up for cv disease
1.3.4. no risk factor for cv disease
1.3.5. enlargment in right cervical lymph node (1cm)
1.4. second trigger cues
1.4.1. tirdness and increasing dyspnea
1.4.2. presented in outpatient clinic
1.5. 10 minutes
2. Step 4
2.1. Hypothesis organization (tentative solution)
2.1.1. malignancy with metastasis (lymphoma)
2.1.2. leukemia
2.1.3. chronic infection (lymphadenitis)
2.2. 20 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. lymphoma and leukemia
3.1.1.1. causes
3.1.1.2. mechanism
3.1.1.3. manifestations
3.1.1.4. how to differentiate between it and leukemia
3.1.2. causes of cervical lymph nodes (right)
3.1.2.1. degree of lymph node enlargment
3.2. 10 minutes
4. Step 2
4.1. Problem formulation (put it in a senates)
4.1.1. 56 y male presented in the outpatient clinic with tirdness and progressive dyspnea with history of right cervical lymph node enlargment and a cv problem concern 20 months ago
4.2. 10 minutes
5. Step 3
5.1. Hypothesis generation (brainstorming)
5.1.1. trigger
5.1.1.1. similar lifestyle as his friend with worry of developing same problem
5.1.1.2. occupation associated with autoimmune diseases
5.1.1.3. high wbc count (lymphocytes)
5.1.1.4. node enlargment might be due to infection or malignancy
5.1.1.5. malignancy (in wbc)
5.1.1.6. infection
5.1.1.7. progressice and chronic condition
5.1.1.8. lymphocyte malignancy puts patient in more risk of infection due to lower immunity
5.1.1.9. lymph node enlargment causing obstruction
5.1.1.10. leukemia leading to anemia
5.1.1.11. might be psychogenic
5.1.1.12. malignancy in the first presentation causing reduction in immunity which lead to the second presentation symptoms
5.1.1.13. autoimmune disease