Greetings and welcome to the first day of your medical residency at Lincoln Regional Medical Center!

We're pleased to have you join our esteemed medical team. At Lincoln Regional Medical Center we pride ourselves on a high standard of patient care, and our medical residents are a key part of our ability to maintain this standard.

Your residency will begin at our walk-in clinic. Patients who visit the clinic are generally too sick to wait for an appointment, but not so sick that they must go to the emergency room. Working here provides a unique opportunity for a new doctor because it lets you participate in the entire patient-care process—from diagnosis to treatment to follow-up.

Your job
Your primary responsibility will be to diagnose and treat patients, following their cases from beginning to end. As the attending physician, I'll be supervising your work, but this shouldn't lessen your sense of responsibility for the patient(s) you see. Your patients are YOUR patients and they are relying on you for their care. In some cases their lives may depend upon you.

Your first patient
Your first case is a patient named Frank McGrath. He came to the clinic this morning complaining of swelling in his abdomen, along with other symptoms his wife noticed. Mr. McGrath is a 55-year-old Caucasian male and a Vietnam veteran. The triage nurse recorded his vitals as:

• Blood Pressure: 120/80
• Pulse: 88 and regular
• Temperature: 98.4 °
• Height: 6' 0"
• Weight 190 lbs

I saw Mr. McGrath briefly and took a short history (which I videotaped so you could watch it; something I often do for my residents). Frankly, I think this guy is in pretty bad shape. We need to run some tests and figure out what's going on.

Your Task
Now he's yours, but you need to keep me informed of everything you're considering, so I can steer you in the right direction if you're headed down the wrong path. I'm going to have you work on a team with a couple of other residents. You should:

• Review the video. As you watch, record relevant clinical findings (signs and symptoms).

• Develop a differential diagnosis (a prioritized list of possible causes/diagnoses). Besides reviewing what a differential diagnosis is and how to create one, you might also want to research the signs and symptoms you observed.

• Determine which relevant tests you can run to gather additional information on Mr. McGrath's condition.

• Prepare a report. Your report should:
• Explain each diagnosis you think is possible given Mr. McGrath's symptoms.
• Detail why you prioritized each diagnosis as you did.
• Include the tests you want to run to confirm (or disconfirm) your primary diagnosis and what you believe each of these tests will show.

I have attached two documents to help you get started. The first is a template I sometimes use called Clinical Findings Research Notes. It helps organize clinical findings, research notes, possible causes, and tests used to confirm or disconfirm the diagnoses. The second is a Diagnostic Report Template to help you organize your final report.

Between Mr. McGrath's history and your research, you should have enough information to put together a diagnosis. I look forward to reviewing your report.

Thanks,

Dr. Jordan Casey
Attending Physician