1. Step 6
1.1. Review session 1
1.1.1. relavent anatomy & physiology of pancreas
1.1.2. physiology of insulin
1.1.3. Diabetes
1.1.3.1. types
1.1.3.2. signs & symptoms
1.1.3.3. pahtophysiology
1.1.3.4. complications
1.1.3.5. diagnosis
1.1.4. skin infections in diabetics
1.2. Report new knowledge
1.3. 30 minutes
1.3.1. The scribe does not have to write in this step!
2. Step 8
2.1. Diagnostic decision
2.1.1. Diabetes 1 complication (leg ulcer)
2.2. Mechanism
2.2.1. uncontrolled type 1 DM causing complication
2.2.2. infection by the 2 organisms
2.3. Presentation
2.3.1. fatigue
2.3.2. polyurea
2.3.3. polydepsia
2.3.4. leg discomfort
2.4. Supporting data
2.4.1. hx and PE
2.4.2. invistigations
2.5. 10 minutes
3. Step 7
3.1. Inquiry plan and info gathering
3.1.1. History of presenting complaint
3.1.1.1. recurring infection in her leg for last 2 mo
3.1.1.2. currently started after the recurring infection recurring causing discomfort in its site
3.1.2. Previous medical / surgical history
3.1.2.1. diagnosed with T1D at age 19
3.1.2.2. had difficulty with diet compliance after the diagnosis
3.1.2.3. had hypoglycemic attack after exercise
3.1.2.4. treated with twice daily injections for 3 mo
3.1.2.4.1. after 3 mo
3.1.2.5. after 12 mo she had hyperglycimc attacks
3.1.2.5.1. weight loss
3.1.2.5.2. fatigue
3.1.2.5.3. blurred vision
3.1.2.5.4. vaginal irritation
3.1.2.6. took medication without consultation
3.1.3. Drug history / allergy
3.1.3.1. taking OC
3.1.3.2. no allergy
3.1.4. Family history
3.1.4.1. no family hx
3.1.5. Social / occupational history
3.1.5.1. born in Australia, after family migration from Italy
3.1.5.2. living with her boyfriend who supports her about caring
3.1.5.3. has 2 younger bro
3.1.5.4. needs job to meet her finantional needs but gets irritable sometimes
3.1.5.5. didn't tell anyone about her condition for 2 yr to not losing her job
3.1.5.6. worried about the impact of diabetes on her job
3.1.5.7. smokes 1 packet / day since 15
3.1.5.8. 2-3 standard drinks in weekends
3.1.5.9. mother has little education, and father is busy
3.1.5.10. aware of diabetes complications
3.1.5.11. above average high school graduate
3.1.6. Systemic review
3.1.7. Physical examination
3.1.7.1. vitals
3.1.7.1.1. BP
3.1.7.1.2. pulse
3.1.7.1.3. RR
3.1.7.1.4. temp
3.1.7.1.5. highet
3.1.7.1.6. wieght
3.1.7.2. inspection
3.1.7.2.1. tired and not wanting to answer many Qs
3.1.7.2.2. tongue was dry
3.1.7.3. palpation
3.1.7.3.1. no enlarged inguinal lymph nodes
3.1.7.4. leg
3.1.7.4.1. area of infection in leg
3.1.7.4.2. 2 cm in diameter
3.1.7.4.3. small area of exudate
3.1.7.5. peripheral sensations are present & equal
3.1.8. tests results
3.1.8.1. urinlysis
3.1.8.1.1. +4 glycourea
3.1.8.1.2. +1 ketones
3.1.8.1.3. +3 proteins