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Case Study

57-Year Old Woman with Fatigue: A Case-Based Exercise for Medical Studentss

This case-based exercise, designed for second-year medical students, covers the principles of management of chronic diseases such as diabetes, hypertension, dyslipidemia, and chronic kidney disease. It provides a structured team-based setting in which groups of medical students can practice clinical reasoning skills. It has been used as part of a series of clinical cases created to help students synthesize what they have learned in different organ system courses and apply their knowledge in a realistic clinical scenario. The exercise could be used at various points in medical students’ training, but participants should have completed coursework in endocrine, cardiovascular, renal, and neurologic systems. In our experience, the modified team-based learning approach that this exercise employs generates lively and clinically sophisticated discussions among second-year medical students.

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Case Study

Case Study: How to Assess and Treat a Patient's Genetic Risk of Coronary Artery Disease?

I had a recent case that prompted the question posed in this headline. The patient is a 48-year-old man, previously healthy (on no meds) whose only cardiac risk factor was a family history. (His father had MI at 53, and died several years later.) He presented with a two-week history of exertional angina punctuated by an episode at rest lasting 20 minutes on the day of admission. His initial exam was normal (BMI=24.2; BP=118/70). EKG showed T wave inversion in leads 2 and 3 and aVF. Labs revealed a troponin of 2.32, and lipid panel showed LDL=112, HDL=41, TG=128, and TC=160. He underwent coronary angiography and was found to have a 90 percent proximal RCA lesion, which was treated successfully with a drug-eluting stent.

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