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Upstate Medical university Case Study

"Pathophysiologic Hypothesis" Format

For each case, you will be asked to electronically submit to Turnitin through Blackboard a hypothesis consisting of a concept map/diagram. Put your ID number on your hypothesis. Be sure to include the ID numbers of fellow students that collaborated with you in generating the hypothesis under your own ID number at the top of your submission (e.g. I worked with: ...). Please note that Turnitin requires a minimum of 20 words of text for submissions; our suggestion would be to include a 1-2 line summary of the case you are submitting the hypothesis on to satisfy this program requirement.

The free concept map program, Cmap, is recommended for creating your diagrams on both Macintosh and Windows platforms. Click here for instructions for using the program (most frequently asked tip: hold down the "Shift" key while drawing lines/arrows to eliminate the text box between phrases ).

It is recommended that you upload your diagram as part of a MS Word (.doc) or Adobe Acrobat (.pdf) document.

Problem List

While not required as part of your written assignment, we recommend beginning the task by generating for yourself a problem list from the clinical description of the case. The problem list ultimately sets the stage as to what needs to be explained in the diagram (described below).  A "problem" is any abnormality that needs to be explained by the disease process, whether sign, symptom, lab or imaging abnormality.

Diagram

Create a diagram that explains (via established pathophysiologic mechanisms of disease) each of the clinical findings on your problem list given the known underlying diagnosis. The style for the diagram should be consistent to insure getting credit for your work. Use the following format:
  • Make it readable. An overcrowded page tends to be uninterpretable and will not likely be assessed positively.

  • The diagram consists of nodes linked together in meaningful ways thus providing an explanation as to how the disease manifestations occurred and how they relate to each other and to the underlying disease process (not a rehash of the timeline of what occurred). Unless otherwise specifically instructed, the hypothesis is about the patient in the case report, not the disease in general. Be sure to focus some attention on both the unresolved issues in the case and those findings with multiple possible causes.

  • Nodes represent findings, processes or diseases (try to keep them to 1 to 3 words). Nodes representing the clinical findings on the problem list should be designated by BOLDED text. The best arrangement is to have the bolded items from your problem list as endpoints around the periphery of the diagram with the disease mechanisms explaining them radiating out from the center.

  • Links are of various types. Solid arrows indicate probable causal relationships; broken arrows indicate inhibitory influences; solid lines indicate other types of relationships such as one of the items being a feature of or supporting evidence for the other item. Students should strive for “global coherence” meaning that all findings are ultimately related to each other in the diagram. Thus, although most aspects of the hypothesis should reflect established relationships, some will necessarily be speculative. Reasonable but unproven hypotheses are encouraged but hypotheses that violate established medical knowledge will be penalized.
Quick reference - utilize the following standard designations for your diagrams:
  1. All of the patient findings (from your problem list) should be BOLDED. The point of the diagram and hypothesis is to EXPLAIN these findings now that you know what the final diagnosis is.
  2. The diagram is NOT a chronology of events and is NOT about the differential diagnosis process.
  3. An ARROW should be utilized for causal relationships (i.e., A leads to B).
  4. Therapeutic interventions that cause part of the disease manifestation should be indicated in RED. Therapy that is not part of the pathogenesis of disease should be omitted from the hypothesis.
  5. A DASHED ARROW should be utilized for inhibitory relationships.
  6. A LINE should be utilized for associated relationships in which causality has not been established.