Case Analysis Tool Worksheet
Student’s Name: Case ID: _AQ_16
I. Epidemiology/Patient Profile
Mr. Fitzgerald is a 68-year-old male who used to work as a bricklayer for more than 30 years presented with an erythematous skin condition that has lasted about 3-4 years. He bikes to work 50 to 60 miles a week.
II. Prioritized Cues from History and PE.
Tier 1 Tier 2 Tier 3
35x25mm Left forearm oval scaly erythematous patch with indistinct borders
Denies smoking
Decreased stream and dribbling of urine for the past four to five months
Long term sun exposure (brick layer for more than 30 years and biking for about 50-60 miles a week)
Used to drink alcohol
Slight right hip pain
Fair complexion
Painless patch
Splenectomy done about 15 years ago due to injury
Increasing age
Seizure disorder was diagnosed about 20 years ago. On carbamazepine.
No history of injury
No family history of skin cancers
III. Problem Statement
Mr. Fitzgerald is a 68-year-old previously healthy male with a history of significant sun exposure who presents with a 35×25 mm erythematous oval patch on his left forearm that has been present for about 3-4 years and has been increasing progressively in size.
IV. Differential Diagnosis
Leading dx: Squamous cell carcinomas in-situ (Bowen’s Disease)
History Finding(s) Physical Exam Finding(s)
Left forearm lesion
35x25mm left forearm oval scaly erythematous patch with indistinct borders
Long term sun exposure (brick layer for more than 30 years and biking for about 50-60 miles a week)
Fair complexion
Alternative dx: Actinic keratoses
History Finding(s) Physical Exam Finding(s)
Left forearm lesion
35x25mm left forearm oval scaly erythematous patch with indistinct borders
Long term sun exposure (brick layer for more than 30 years and biking for about 50-60 miles a week)
Alternative dx:
Basal Cell Carcinoma
History Finding(s) Physical Exam Finding(s)
Left forearm lesion
35x25mm left forearm oval scaly erythematous patch with indistinct borders
Long term sun exposure (brick layer for more than 30 years and biking for about 50-60 miles a week)
V. Explanation of Diagnostic Plan and Treatment Plan in prioritized order:
Diagnostic Plan Rationale
Incisional / punch biopsy
Risk for skin cancer is high due to the patient’s work history as a bricklayer and uses a bike to work (McCance & Huether, 2019)
Treatment Plan Rationale
Wide excision under local anesthesia in the office
Patch is in a relatively low risk in a cosmetically insignificant area. Wide excision can take out a wide margin of abnormal cells to ensure that only healthy tissue is left behind (McCance & Huether, 2019).
Mohs microscopic surgery
Referral might not be necessary because margins are clearly visible.
The purpose of the Aquifer assignment is to teach you how to synthesize important patient information gathered during an office visit to select appropriate differentials and create subsequent diagnostic and treatment plans.
The Aquifer assignment is not a summarization of the Aquifer case, or an essay on the specific illness/disease presented.
The written portion of the Aquifer assignment should clearly outline your rationale for selecting your leading diagnosis and differentials, given the information collected for the patient presented.
While the write up needs to include an appropriately formatted title page per APA 7 guidelines, a formal introduction and conclusion are not needed.
An example outline of the written assignment should include would be as follows:
Leading Diagnosis
(this is the diagnosis for which diagnostic and treatment plan will be written)
The leading diagnosis for this patient is ****. Leading diagnosis is supported by patient’s presenting symptoms of ***** (
citation of a Clinical Practice Guideline or Problem Specific Peer Reviewed Reference supporting findings). Supporting physical assessment findings include ****** (
citation of a Clinical Practice Guideline or Problem Specific Peer Reviewed Reference supporting findings).
Differential Diagnoses (must have 2 differentials)
Differential 1 (e.g. Influeza)
The first differential in this case is **** supported by patient presentation of *** (
citation of a Clinical Practice Guideline or Problem Specific Peer Reviewed Reference supporting findings). The differential is further supported by physical exam findings of **** (
citation of a Clinical Practice Guideline or Problem Specific Peer Reviewed Reference supporting findings). *** is less likely however due
*(here you would present s/s, history physical exam
findings that rule out differential)
* (
citation of a Clinical Practice Guideline or Problem Specific Peer Reviewed Reference supporting findings).
Differential 2 (e.g. Viral pharyngitis)
*** is the second possible differential in this case. Differential is supported by patient’s presenting symptoms of **** (citation). Patient’s physical assessment findings of *** further support the differential however, differential is less likely due to *** (
citation of a Clinical Practice Guideline or Problem Specific Peer Reviewed Reference supporting findings).
Diagnostics
Here you would outline your diagnostic plan including any pertinent diagnostic test(s) or exam(s) indicated for diagnosis (must include
citation of a Clinical Practice Guideline unless not available. If no guideline is available may use a
Problem Specific Peer Reviewed Reference
).
Brief statement regarding why test is being used, e.g. Positive RADT results are confirmatory for GAS in pediatric pa
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