Second Year

SGD CASE (Cardio 3rd Week)

INSTRUCTIONS

1. Read and study the case below. Concept guides are provided to assist you in which topics to study.
2. Length of time: 3 hours per small group discussion
3. Time for preparation: 1 week prior to the schedule of the meeting
4. Rotating roles of group members: leader, secretary, moderator
1. Leader: secures copy of the case, assigns roles, initiates case discussion
2. Secretary: checks attendance, lists ideas, writes down concept map for discussion
3. Moderator: keeps the flow of discussion on track and mediates arguments
5. Present a concept map at the end of the SGD. The following link can serve as a guide for concept
map construction: https://www.youtube.com/watch?v=FSrlIP3yVj

LEARNING OBJECTIVES

1. Discuss the case of a 65-year-old male who presented right lower leg pain.
1. Identify important symptoms and other details in the history to arrive at a diagnosis.
2. Correlate the physical examination findings with disease pathogenesis.
2. Identify the different risk factors and understand the pathogenesis of peripheral vascular disease.
3. Interpret laboratory findings and correlate them with disease pathogenesis.
4. Present a concept map demonstrating understanding of the case and relevant concepts.

THE CASE

A 65-year-old man complains of right lower leg pain when walking for the past six months. He describes
the pain as cramping. The pain is worse after he walks a few minutes, and improves with rest. Sometimes
he notices coldness, numbness, and tingling in his right foot, especially at night. He was diagnosed with
hypertension and hyperlipidemia over 10 years ago. He has no history of trauma, infection, or ulceration
in the lower extremities.

Physical Examination
Vital signs: BP 160/90 mmHg, PR 80 bpm, RR 18 cpm, T 36.5°C, oxygen saturation 97% on room air
Cardiovascular: regular rhythm, no murmurs, gallops, or rubs. Normal S1 and S2 sounds. No jugular venous
distension or peripheral edema.
Respiratory: clear to auscultation bilaterally. No wheezes, crackles, or rhonchi.
Abdominal: soft and non-tender. No masses, organomegaly, or bruits.
Extremities: normal range of motion and strength. No cyanosis, clubbing, or deformity. Right dorsalis pedis
pulse weakly palpable. Left dorsalis pedis pulse normal. Capillary refill time >3 seconds on right foot. Skin
temperature decreased on right foot compared to left foot. Hair loss on right lower leg. Thickened and
opaque toenails on both feet.

CONCEPT GUIDE

Physical Diagnosis
 History and physical examination of the cardiovascular system

Southwestern University – PHINMA Villa Aznar, Urgello St., Cebu City, Philippines
T +63. 32. 415. 5555 | www.swu.edu.ph
General and Clinical Pathology
 Peripheral Vascular Disease

Pharmacology
 Antiplatelet agents
 Drugs for dyslipidemia and hypertension

RECOMMENDED RESOURCES

 Bates’ Guide to Physical Examination and History Taking, 13 th edition

 Robbins and Cotran Pathologic Basis of Disease, 10 th edition
 Henry’s Clinical Diagnosis and Management by Laboratory Methods 24 th edition
 Katzung Basic and Clinical Pharmacology 15th edition

GUIDE QUESTIONS
1. Present a differential diagnosis for this case with justifications.
2. List information that should have been elicited from the patient’s history and physical
exam that would help narrow down the differential diagnosis.
3. List additional tests that should be ordered for this patient, with justification for each test
and expected results for this patient.
4. What is the underlying pathophysiology for peripheral vascular disease (PVD)?
5. What are the modifiable risk factors for PVD?
6. What medications may be prescribed to patients with PVD?
7. What are the non-pharmacologic treatment options for PVD?

Southwestern University – PHINMA Villa Aznar, Urgello St., Cebu City, Philippines
T +63. 32. 415. 5555 | www.swu.edu.ph