Walking Uphill - Session 1

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Walking Uphill - Session 1 by Mind Map: Walking Uphill - Session 1

1. Step 1

1.1. Identify terms and cues

1.2. New terms

1.2.1. clutching

1.2.1.1. tightness

1.2.2. solicter

1.2.2.1. lawyer

1.2.3. cramping

1.2.3.1. muscle spasm

1.3. cues

1.3.1. man in seventies

1.3.2. retires lawyer

1.3.3. clutching in his chest

1.3.4. discomfort in chest when walking

1.3.5. exceration when walking between shoots

1.3.6. presented to the GP

1.3.7. uncomfortable cramping in his calf muscle (right)

1.3.8. limiting his activity

1.3.9. cannot keep up with his friends

1.3.10. holding golf cart for support

1.3.11. golf is his favorite hobby

1.4. 10 minutes

2. Step 4

2.1. Hypothesis organization (tentative solution)

2.1.1. ischemic heart disease

2.1.1.1. atheroscelorosis

2.1.1.2. arteriosclerosis

2.1.2. prepheral artery disease

2.1.3. trauma in chest and legs

2.1.3.1. ask in the history to exclude

2.1.4. respiratory problem

2.1.4.1. ask in history to exclude

2.2. 20 minutes

3. Step 5

3.1. Formulate learning objectives

3.1.1. relevant vascular anatomy

3.1.2. ischemic heart disease

3.1.2.1. causes

3.1.2.1.1. is it atheroscelorosis ??

3.1.2.2. risk factors

3.1.2.3. mechanism

3.1.2.4. diagnosis

3.1.3. calf muscle cramp

3.1.3.1. prepheral artery disease

3.1.3.1.1. in lower extremity

3.1.3.1.2. causes

3.1.3.1.3. risk factors

3.1.3.1.4. mechanism

3.1.3.1.5. diagnosis

3.1.3.2. is there other causes

3.2. 10 minutes

4. Step 2

4.1. Problem formulation (put it in a senates)

4.1.1. a retired solicter male in his seventies presented to GP complaining of chest discomfort when walking with uncomfortable cramping in his calfs muscle especially the right.

4.2. 10 minutes

5. Step 3

5.1. Hypothesis generation (brainstorming)

5.1.1. chest pain

5.1.1.1. angina on exertion

5.1.1.1.1. blockage in the coronary artery

5.1.1.1.2. ischemic problem by atherosclerosis plaque

5.1.1.1.3. the heart cannot meet the demand during activity

5.1.1.1.4. blockage or stenosis in one of the myocardium

5.1.1.1.5. diabetes preceptate the formation of the plaque

5.1.1.2. pain caused by trauma

5.1.1.3. muscle strain or spasm

5.1.1.4. plurtic chest pain

5.1.1.4.1. pneumothorax or pneumonia also PE

5.1.1.5. visceral pain because they are innervated by ANS so it cannot be localized

5.1.1.6. heart failure but in compensating stage which makes him more prone to ischemia

5.1.1.7. normal changes because of aging leads to multiple formation of thrombus

5.1.1.7.1. precipitated by high cholesterol intake and low activity

5.1.1.8. pericardial effusion

5.1.2. calf cramping

5.1.2.1. another narrowing or stenosis leads to lower oxygen

5.1.2.2. rupture plaque

5.1.2.3. hypercholesterolemia leads to formation of atherosclerosis plaque

5.1.2.4. atherosclerosis without rupture but there is no complete occlusion

5.1.2.5. low oxygen leads the muscle to cramp faster

5.1.2.6. pain of diabetic foot

5.1.2.7. injury to lower limbs

5.1.2.8. prepheral arterial disease

5.1.2.9. arteriosclerosis

5.1.2.10. environmental caused by cold which leads to vasospasm

5.2. 40 minutes