Clinico-pathological correlation report: Diagnosis, Symptoms, Pathology and Treatment

Case Study

In a hot summer day back in 2010, Thomas Wailer, 34-year old man, presented to his GP. He had been feeling generally unwell for several weeks. Below is an account of the consultation on the day of his visit to the GP and the follow-up investigations:‘’Thomas reports that he has been having persistent episodes of diarrhoea and loose stools. What has been concerning him most is that he has been passing a lot of bright red blood and mucus. He tells the GP that he has been going to the toilet up to 15 times per day. He had a previous episode of this a few months previously but it was not as severe and so he just waited for the episode to pass. Thomas has been feeling very tired and the GP notes that he looks very pale. He examines Thomas and finds that he has some generalised tenderness of his abdomen, and thinks he can feel an enlarged liver. On further questioning it is revealed that he took a holiday in Caribbean over Christmas holiday and at the time he was fit and well. Thomas has also lost weight and appears dehydrated. He has had no previous abdominal surgery. The GP arranges for him to have a blood test.

 

You are required to write a clinico-pathological correlation report based on the patient’s pathology and his pharmacological treatment.
Within your report, make sure you include the following: - this is NOT an exhaustive list! An excellent report will be a work of synthesis, showing clearly how treatment, diagnosis, symptoms, pathology and underlying mechanisms are related to each other.
Within your report, make sure you include the following:

 

1. Make a diagnosis – what condition do you think this patient has?

2. Explain the patient’s symptoms and signs in relation to your proposed diagnosis.

 
3. Describe the pathology behind his condition and how it progresses.

4. Why are steroids prescribed? Why are they used in this situation? Why do the doctors wait for the stool culture result before prescribing them?

5. What are the cellular or molecular targets and the intended therapeutic results of prescribing sulfasalazine? 
6. What immunosuppressive drugs was he most likely prescribed? Given your proposed diagnosis, acknowledge how these agents exert their desired therapeutic effects by explaining their mechanism of action.

 
7. Interpret the macroscopic and histological images and refer to them in making your response

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8. What do the blood test results indicate? Can you explain the changes to the liver function tests and haemoglobin?

1. Diagnosis

9. What complications can occur as a result of this condition?

10. Discuss the impact that having a stoma will have for our patient?

Appropriate and correct use of references (Harvard Referencing Style) is expected as a matter of course. Do not use anonymous web sources and patient support groups.

A. Organisation, logic and presentation of the report (15%)
B. Knowledge and understanding of the case and related pharmacology (85%)
? Diagnosis with explanation (10)
? Correlation of signs/symptoms/test results with pathology (40)
? Understanding of immunosuppressive and steroid therapy (10)
? Explanation of the pathogenesis and complications of the condition (15)
? Interpretation of the macroscopic and histological images (10)

1. Make sure you answer all aspects of the question – it is not simply a description of the disease process.

2. A clinic-pathological correlation requires you to relate the signs and symptoms of the patient to the underlying pathological process.

 
3. Grammar, spelling and organisation are important and are worth valuable marks – do not neglect these.

4. Do not use anonymous web sources and patient support groups – the information is often wrong. Cite your references correctly.

5. Make use of pathology images - always label and annotate pathology pictures.

6. When making a diagnosis think about the other possible conditions that could form part of a differential diagnosis.

a.  Avoid giving the diagnosis in the first sentence of the report.

b. Make sure you explain the signs and symptoms, the investigation results etc… as clearly and logically as you can. Give a differential diagnosis (whatpotential diseases could be responsible for this?) and then explain what you think the diagnosis actually is and why it is not one of the other possibilities.

c.  Make sure you have attempted to answer all parts of the case (i.e. allresults, signs, symptoms explained etc. I.e. don’t cherry pick the things you know and ignore the others) and that you have addressed all the points made in the guidelines.

d. Include pictures where appropriate (normal versus abnormal for clear comparison) – label histology/macroscopic images as clearly and detailed as you can (very important!)

c. Organisation of your report – divide into sections and sub-sections. Make sure the report is well structured and flows like a nice story (not just a haphazard mess!)

d. At the beginning of the report, it is a good approach to summarise the salient features of the case history as an introduction.

e. Finish your report by summarising the most important points that you have identified from the case.

f. Do not forget to check your spelling and grammar and make sure you use the Harvard Referencing style

• Comment on patient data (physiological measures, biopsy) to suggest the pathological mechanism.
• Justify the use of particular drug classes.
• Explain the drug action at the target.
• Account for changes from normal physiology in terms of common pathological mechanisms. 
• Higher order learning skills of interpretation and justification

We want to give you maximum credit for your original contribution to this assignment. In order to for us to do this, you must indicate the extent of your reliance on the work of others.

1. I have not relied on any other student's unacknowledged input or data?

 

2. I have not reproduced material from a previous assignment submitted by any author to any institution?

 

3. I have not sought or received the services of any professional writer or agency?

 

4. All sources have been acknowledged, and cited in Harvard format?

 

5. In making use of an acknowledged source, I have extracted its meaning and expressed it in my own words. I understand that copy/pasting, and extensive paraphrasing of lengthy sources should be avoided, especially where the structure of that source is preserved in my text.

 

6. I know that anonymous and non-academic websites are unsuitable as sources. Information retrieved from these sites should be confirmed by a peer-reviewed source.

 

7. I have read and understood the material behind the Academic Misconduct Policy And Procedures tab.

 

8. I know that plagiarism is an assessment offence, and will attract disciplinary action. This may lead to failure of the entire modular.