1. Step 4
1.1. Hypothesis organization (tentative solution)
1.1.1. neoplasm
1.1.1.1. colo-rectal cancer
1.1.1.2. polyps
1.1.2. GI abnormality
1.1.2.1. inflammatory process
1.1.2.1.1. IBD
1.1.2.1.2. diverticulitis
1.1.2.1.3. infections
1.1.2.1.4. ischemic colitis
1.1.2.2. hemorrhoid
1.1.2.3. anal fissure
1.2. 20 minutes
2. Step 1
2.1. Identify terms and cues
2.2. New terms
2.2.1. strain
2.2.1.1. forceful
2.3. cues
2.3.1. 38 yo woman
2.3.2. episodes of rectal bleeding with changes in bowel habits
2.3.3. constipation with pain and difficulty
2.3.4. need to visit the toilite several times
2.3.5. told she required urgent operation
2.3.6. blood stained mucous in the paper
2.3.7. previous bowel habit was "clockwork"
2.3.8. strain to pass the motion
2.3.9. concerned about her childern
2.4. 10 minutes
3. Step 5
3.1. Formulate learning objectives
3.1.1. colo-rectal neoplasm
3.1.1.1. pathophysiology
3.1.1.2. risk factors
3.1.1.3. types
3.1.1.4. staging
3.1.1.5. 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. 38 yo female presented for consultation about undergoing operation after having rectal bleeding and change in bowel habit, constipation, difficulty emptying the bowel. She noticed blood stained mucous after wiping.
4.2. 10 minutes
5. Step 3
5.1. Hypothesis generation (brainstorming)
5.1.1. Rectal bleeding
5.1.1.1. abnormality in lower GIT
5.1.1.1.1. anal fissure
5.1.1.1.2. hemorrhoid
5.1.1.2. could come from proximal GI
5.1.1.2.1. peptic ulcer
5.1.1.3. something not related to the stool itself explained by blood stained mucous
5.1.1.4. complicated inflammatory process
5.1.1.5. complication of previous surgeries
5.1.2. bowel habit
5.1.2.1. constipation
5.1.2.1.1. over absorption of water from stools, reflecting abnormality in motility in colon
5.1.2.1.2. protrusion of the tract
5.1.2.1.3. ulcerative colitis might lead to bleeding and constipation
5.1.2.1.4. explained purely with the diet and hypothyroidism
5.1.2.2. difficulty emptying the bowel
5.1.3. Urgent OP
5.1.3.1. because of the blood loss
5.1.3.2. complete obstruction
5.1.3.3. metastised tumor