1. Step 4
1.1. Hypothesis organization (tentative solution)
1.1.1. Chronic kidney disease
1.1.1.1. decreased GFR and increased Cr
1.1.2. metabolic syndrome complication
1.2. 20 minutes
2. Step 1
2.1. Identify terms and cues
2.2. New terms
2.2.1. none
2.3. cues
2.3.1. 52 yo male
2.3.1.1. taxi driver
2.3.2. feels and looks tired
2.3.3. high serum Cr levels
2.3.4. eGFR 45
2.3.5. risk factors T2DM and HTN
2.3.6. mild swelling around his ankles
2.3.7. overwheight
2.4. 10 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. Chronic kidney disease
3.1.1.1. definition
3.1.1.2. epidemiology
3.1.1.3. causes
3.1.1.3.1. hypertention
3.1.1.3.2. diabetes
3.1.1.4. pathophysiology
3.1.1.5. clinical presentation
3.1.1.6. diagnosis
3.2. 10 minutes
4. Step 2
4.1. Problem formulation (put it in a senates)
4.1.1. 52 yo man with history of type 2 DM and HTN, found to have serum Cr 190 and GFR 45, complaining of tiredness. He is slightly overweight and has ankle swelling.
4.2. 10 minutes
5. Step 3
5.1. Hypothesis generation (brainstorming)
5.1.1. elevated serum Cr
5.1.1.1. false positive, such as eating meat
5.1.1.2. dehydration?
5.1.2. reduced GFR
5.1.2.1. aging process resulting in reducing nephrons number
5.1.2.2. nephrosclerosis?
5.1.2.3. HF decreases effective circulating volume leading to pre-renal cause
5.1.2.4. leading to increased serum Cr
5.1.3. tirdeness
5.1.3.1. high uremia causes lethargy
5.1.3.2. long term DM and HTN cause scleroting vessles
5.1.3.3. anemia
5.1.3.4. non-specific?
5.1.3.5. hydrogen secretion abnormality leading to metabolic acidosis
5.1.4. overwheight
5.1.4.1. metabolic syndrome?
5.1.5. ankles swelling
5.1.5.1. heart, liver, renal causes
5.1.5.2. long standing HTN leads to LVH, finally HF