The document provides guidelines for managing a hypothetical patient with a health problem through various triggers. It outlines questions to be addressed at each trigger, including determining possible causes, selecting diagnostic tests, interpreting results, reaching diagnoses, and formulating treatment plans. The guidelines aim to assess understanding of pathophysiology, pattern recognition, clinical reasoning, and management of the patient's condition from initial presentation through treatment and prognosis.

1. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 1
Patient with complaint of “The Health Problem” (Chief
Complaint)
Questions:
1. What is “The Health Problem”?
2. What are the possible causes of “The Health
Problem”?
Organs/tissues General condition/ Specific condition/
involved disorder disease
(e.g. trauma, cancer,
infection)

2. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 1
Patient with complaint of “The Health Problem” (Chief
Complaint)
Questions:
3. What do you think are the more common/least
common general and specific condition causing
the health problem?
General condition/ Specific condition/
disease disease
More common ______________ ________________
Least common_______________ ________________

3. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 1
Patient with complaint of “The Health Problem” (Chief
Complaint)
Questions:
4. Select one common general or specific condition
and diagram the pathophysiology
leading to the health problem.

4. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 2
Pertinent history
Age, sex / Chief complaint / When noted / Associated
symptoms
Physical examination:
Questions:
1. What is your primary and secondary diagnosis?
Primary diagnosis: __________________
Secondary diagnosis: ________________

5. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 2
Pertinent history
Age, sex / Chief complaint / When noted / Assoc.symptoms
Physical examination
Questions:
2. What are the bases for your primary and secondary
diagnoses?
Demonstrate use of pattern recognition with
pathophysiology and prevalence.
Signs/Symptoms/Pathophysio
Prevalence data
Primary diagnosis:
Secondary diagnosis:

6. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 2
Pertinent history
Age, sex / Chief complaint / When noted / Assoc.symptoms
Physical examination
Questions:
3. Do you need more data (sign/symptom) to firm up your
primary and secondary diagnoses?
If yes, what? How will it firm up your diagnosis?
[ Data asked for either not available or normal. Facilitator may
supply other data.]

7. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 2
Pertinent history
Age, sex / Chief complaint / When noted / Assoc.symptoms
Physical examination
Questions:
4. Do you need a paraclinical diagnostic procedure?
If yes, why? If no, why?
Demonstrate use of
1. certainty/uncertainty of primary and secondary
diagnoses
2. plan of management for primary and secondary
diagnoses
3. others

8. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 2
Pertinent history
Age, sex / Chief complaint / When noted / Assoc.symptoms
Physical examination
Questions:
5. If you need a paraclinical diagnostic procedure, what will
you recommend? Why?
Give at least 3 options and then compare using benefit,
risk, cost, and availability factors. Then select
one demonstrating priority on the primary
diagnosis. Shotgun policy is NOT acceptable.

9. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 2
Pertinent history
Age, sex / Chief complaint / When noted / Assoc.symptoms
Physical examination
Benefit Risk Cost Availability
Option 1
Option 2
Option 3

10. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 2
Pertinent history
Age, sex / Chief complaint / When noted / Assoc.symptoms
Physical examination
Questions:
6. Suppose the patient agreed to your recommendation of the
paraclinical diagnosticprocedure and suppose it was done.
What results will firm up your primary diagnosis?
What results will make you shift to your secondary
diagnosis as the primary diagnosis?

11. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 3.
A paraclinical diagnostic procedure was done.
A ___________________________________ was done.
[Here is the picture/reading/result of the paraclinical
diagnostic procedure.]
Questions (as applicable):
1. Examine the result of the paraclinical diagnostic procedure
and then interpret.
Decide whether the result is informative or non-
informative.
Informative, why? Non-informative, why?

12. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 3.
A paraclinical diagnostic procedure was done.
A ___________________________________ was done.
Questions:
2. After the paraclinical diagnostic procedure, what is now
your primary and secondary diagnosis? Why?
Demonstrate use of pattern recognition with
pathophysiology and prevalence.
Diag Proc/Signs/Symp/Pathophysio/Prevalence data
Primary diagnosis:
Secondary diagnosis:

13. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 3.
A paraclinical diagnostic procedure was done.
A ___________________________________ was done.
Questions:
3. Do you need to firm up your diagnosis before you proceed
to treatment? If yes, how?
What data do you need?
History?
Physical exam?
Other diagnostic procedure?
Observation and monitoring?
[Data asked for either not available or normal. Facilitator may
supply other data.]

14. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 3.
A paraclinical diagnostic procedure was done.
A ___________________________________ was done.
Questions:
4. What is your pretreatment primary and secondary
diagnoses?
5. State the goals of treatment for your primary diagnosis?

15. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 3.
A paraclinical diagnostic procedure was done.
A ___________________________________ was done.
Questions:
6. Decide on a treatment modality after comparing the options
based on benefit, risk, cost, and availability factors.
Benefit Risk Cost Availability
Nonoperative
(Specific procedure in mind)
Operative
(Specific procedure in mind)

16. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 3.
A paraclinical diagnostic procedure was done.
A ___________________________________ was done.
Questions:
7. Describe the things need to be done during the
pretreatment, intratreatment, and posttreatment phase.
8. Decide how you would evaluate the results or outcome of
your proposed treatment.

17. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 4
The diagnosis of the patient’s health problem is
____________________________________________
Questions:
1. Advice the patient and relatives on the pathophysiology of
the disease. Use diagram.
2. Advice the patient and relatives on screening of the disease.
3. Advice the patient and relatives on early detection of the
disease.

18. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 5
A case write-up of a patient with a complaint of “The
Health Problem”.
DIAGNOSIS IS NOT SPELLED OUT!
Signs and symptoms
Course in the management
Paraclinical diagnostic procedures done
Treatment
Outcome

19. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 5
A case write-up of a patient with a complaint of “The
Health Problem”.
Questions:
1. Study the case and then decide on the primary and
secondary diagnoses.
Give bases for your diagnoses using
pattern recognition with pathophysiology
prevalence

20. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Trigger 5
A case write-up of a patient with a complaint of “The
Health Problem”.
Questions:
2. Study the case and then
2.1 Comment on the outcome of treatment.
Were the goals of treatment achieved? Yes,
why? No, why?
2.2 Describe the prognosis after treatment.
Recurrence, survival, quality of life
Pathophysiology of the disease leading to
physical disability and death

21. GUIDELINES AND FORMAT
ON
HYPOTHETICAL PATIENT MANAGEMENT
Criteria to be used in evaluation
Clear
Adequate in terms of content
Data for the triggers
Answers to the questions
Format followed
Presence of references
Within the prescribed length (not more than 10 pages
of short bond papers, double-spaced)