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Is there anything else you feel I should know about? 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Hypertensive cardiomyopathy
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Hypertensive cardiomyopathy
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Hypotrophic cardiomyopathy
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Hypotrophic cardiomyopathy
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ACTIONS
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Perform a physical examination
Select what you would like to check
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Well to be honest...I was barely even able to find the energy to come in today, doc. I’ve been so tired lately and I feel like it’s like gotten worse with time. I'm having a hard time catching my breath just walking around the house, especially when I go up the stairs. I took that as a sign that I needed to see the team at The UCL.
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Perform a physical examination
Select what you would like to check
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Try again



There are errors in your diagnostic pathway.
Correct the errors and try again
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Oh, and I've also noticed my legs and feet swell from time to time. Sometimes to the point where my shoes feel tight!


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I mean besides feeling tired and short of breath all the time, sometimes I get this pain in my chest like when I take in a deep breath or even if I move the wrong way. Also, when I lay down sometimes I feel really out of breath. It even wakes me up some nights and messes up my sleep because I need to sit up or stand up for a while to feel better and by then I only get a couple hours of sleep.
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ACTIONS
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ACTIONS
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ACTIONS
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ACTIONS
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DECISIONS
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Welcome to the Case Room.


Now, as the name suggests, this is where we keep all of our current and past case files.


Obviously, you’ll need the patient case file in order to begin your assessment.


Be sure to have a good search around the room as the file you’re looking for might not be immediately accessible. You’ll need to find it quickly as our patient is waiting.













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Great Work



That’s it! You can now interact with objects.






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DECISIONS
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DECISION
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Lab Phase 1: The Whiteboard


Judging by those scribblings on the whiteboard, it appears one of my UCL colleagues has already started building a diagnostic pathway for this Etiologic diagnosis.


That seems like a logical place for you to pick up from. You should fill in the missing pieces before moving on.
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Lab Phase 2: Ordering tests


Once that's complete you'll be in a better position to order some specific diagnostic tests and use the results to hopefully complete your final diagnosis.



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The Lab


Welcome to the Advanced Research and Diagnosis Room here at The UCL. In this room you'll find all our latest and most advanced research, you’ll want to pay particular attention to our findings relating to Infiltrative Cardiomyopathy.


It’s all in here so be sure to take a good look around.


These cases are rare and you may not have encountered it before so you may find the data we have useful in making a diagnosis.




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Welcome to the U.C.L


*clears throat* Well hello, yes, hello and welcome.
Welcome to the Unexplained Cases Laboratory, or The U.C.L. as we affectionately call ourselves.


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The Facility


The lab is run by a Director who is ultimately responsible for the success outcomes. Successful outcomes are achieved when patient care is enhanced through the diagnosis of otherwise unexplained or misdiagnosed cases.


The lab consists of a number of rooms that are also available virtually. They include consultation rooms, research labs and collaborative spaces that can be used by the visiting specialists. The facility is across a single floor and maintains a consistent architectural style throughout.


The look is minimal and focused on patient care so is not overly grand. Natural wood, metal and white surfaces are used in construction whereas marble and ornate woodwork is not.


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Welcome to the patient consultation room


The patient is here


You can select from the following actions:


- Questions you'd like to ask the patient
- Test results you'd like to review
- Examinations you'd like to perform




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The Rooms: Patient Consultation


These are modern clinical spaces where HCPs can consult with patients and perform examinations with appropriate privacy. The rooms allow test results to be analysed and patients to sit or lie in comfort during their consultation.
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The Rooms: Case Room


A functional yet modern office space in a clinical setting. It is where patient files are stored and HCPs conduct preliminary research and investigation into the cases. The room contains shared workspaces including desks and chairs for HCPs to review case files and keep up to date with the latest news in the lab and the wider profession.


There are filing cabinets and other office furniture (trash cans, computer terminals, filing trays, bookshelves, wall space for posters, desk lamps etc) creating lots of places for objects to be placed and interacted with. The room has no windows and two doorways, one from the reception and one leading to the patient consultation room. The lighting in the room is not uniform and creates areas of light and shade. Objects in areas of light clearly stand out while those in the darkness are more circumspect but can still be seen clearly.
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The Rooms: Advanced Research & Diagnosis Lab


This is a lab environment in a specifically clinical setting. It is modern and functional allowing HCPs to order and review test results as well as providing access to cutting edge research on rare disease.
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There is a list of possible Etiologic diagnoses available for you to consider


This is a complex case so please take time to review all the sources of information available to you.


Once you're confident in one, go to the computer by the window, select it and hit submit to move to the next step








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The Rooms: Reception


A modern room with lots of natural light. It is warm and welcoming while maintaining its sense of minimalism.
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Head over to the patient consultation room


Your patient has now arrived.


You can now conduct a consultation with them.


The consultation room is through this door and along the corridor.
Meet me there.






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Congratulations on locating the patient file



We'll be sure to make it easier to find next time.


Make sure you take your time to review every detail, even take some notes if you feel like you have to.


You'll be able to review the test results again during the consultation.




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Welcome to the U.C.L


The Unexplained Cases Lab (UCL) is a facility that patients with rare and unexplained cases are referred to.


The UCL is an independent facility funded through medical research grants and covers cases globally. The lab operates collaboratively with HCPs, and has a small footprint with respect to full-time employees. However, the lab will bring together experts from across the industry to work on cases in the hope of accurate and timely diagnosis for the patients.


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Neck veins examination...
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Listening to Lungs...
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Stethoscope:


• Bibasilar crackles


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Finger Pulse Oximeter:


• 98% Oxygen Saturation


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Taking a pulse oximetry reading...
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HEENT Examination...
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Observation (plus instruments):


• Normal


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What did you find out?


Did you manage to diagnose Mr. Collins?








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I believe congratulations are in order!


Despite the complexities of the case, you achieved a successful diagnosis for the patient, and in such a timely manner too!


Really excellent work.






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Infiltrative cardiomyopathy
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Observation / Palpation:


• Hydrated


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Skin Examination...
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Pulmonary hypertention
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Pulmonary hypertention
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Palpation:


• Hepatomegaly - 40mm from right costal margin


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Abdomen Examination...
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Extremities Examination...
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Observation / Palpation:


• Mild edema (swelling) in lower limbs


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Stethoscope:


• Normal - S1 S2, + S4
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Listening to heart...
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Perform a physical examination
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Kidney Disease
HTMLText_34433B42_2683_3F19_41C3_1D4E793B23F7.html =


Kidney Disease
HTMLText_35B080F0_2683_2AFA_4194_639C31A27BBE.html =


Infiltrative cardiomyopathy
HTMLText_37918338_127C_9AD4_4185_3730B4397BB3.html =


Observation / Palpation:


• Elevated jugular venous pressure


• JVD 3 cm above clavicle


HTMLText_3865CB63_269F_5F1F_41A5_217DE25654A4.html =
Unfortunately we don't believe that
its Hypertrophic Cardiomyopathy



REASONS WHY NOT?


There are also other cardiac and non-cardiac symptoms that appear to be key indicators.










HTMLText_38CA6943_2683_5B1F_419C_81C9D5CC5747.html =
Congratulations!



Congratulations you made a great Etiological diagnosis!


Now is the time to see if those suspicions are correct.






HTMLText_38CCC943_2683_5B1F_41BD_6CAF8F997F79.html =
Get to the Advanced Research Lab


You’ll need to dig a little deeper so I’ll give you access to our most advanced research resources.


Exit the patient room, and head back out into the corridor, then go through the door to the Advanced Research Lab.






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HTMLText_39B1E08D_2CEB_4BBD_41B8_868ADDAC764E.html =
Order the neccesary tests


You can use the computer terminal in this room to order any additional tests you believe are necessary.


And remember, you can refer back to your completed diagnostic pathway at any time.





HTMLText_39B32077_2CEB_4B6D_41B3_662122D9D333.html =
Excelent Work


It looks like you’ve correctly assembled the diagnostic pathway you need.
So now is the time to put that pathway into action!


I believe you are very close to diagnosing the patient.








HTMLText_39F8B143_2CEB_CAA5_41C5_24FC2FD2FF13.html =
Unfortunately you shouldn't be ordering that test at this stage.


We should first rule out AL Amyloidoses. AL requires timely treatment so a prompt diagnosis is crucial for a positive prognosis for the patient.


Please select a different test.











HTMLText_3AA1376C_251E_9593_41B1_D82CEB2B403C.html =
Select all the potential diagnoses that apply:
HTMLText_3B20BFB1_269F_377B_41BC_A66483586F83.html =
Unfortunately we don't believe that
its Pulmonary Hypertension


REASONS WHY NOT?


There are also other cardiac and non-cardiac symptoms that appear to be key indicators.










HTMLText_3B216D51_269F_DB3D_418F_9D9875DE1AC6.html =
Unfortunately we don't believe that its
Kidney Disease.


REASONS WHY NOT?


There are also other cardiac and non-cardiac symptoms that appear to be key indicators.











HTMLText_3B31B087_2ECC_0423_418B_499480A8AFC9.html =
Great Work



That’s it! You can now interact with objects.






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Muscular-Skeletal Examination...
HTMLText_3C2EC2B8_251B_ACF3_41C2_1D7503181D04.html =


Observation / Palpation:


• Normal


HTMLText_3CB316F3_29B9_9B73_41BB_321ACF6DF77D.html =


Copyright © 2021 Pfizer Inc. All rights reserved. FM-VDQL-0125


This patient profile is adapted from a real clinical case with permission from the physician and contains de-identified clinical data



HTMLText_3D83848C_251B_9493_4188_6408BB59FAFA.html =


Observation:


• Good condition
• Hydrated
• No blueish tint (acyanotic)
• No Fever (afebrile)


HTMLText_3D8CA48C_251B_9493_41AA_AF4659D2C2A1.html =
General appearance examination...
HTMLText_3DAC21DF_29B7_F9B3_41C1_5C4BE174640E.html =
THE PATIENT FILES PRESENTS
______________


The unexplained case of
Ben Collins
HTMLText_3DF329D3_26FD_3B3E_41C0_BF15B35B0553.html =
Great Work



That’s it! You can now interact with objects.






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Unfortunately we don't believe that your etiological diagnoses is accurate.


Take a closer look at the cardiac and noncardiac features.














HTMLText_40157A0D_68D5_56A9_41D2_DDCA85EBE830.html =
Great Work



That’s it! You can now interact with objects.






HTMLText_4017BA0D_68D5_56A9_41D4_288086B0F283.html =
In which cabinet?


These are the cabinets that hold all the patient files, some of them appear to be locked. There are lots of case files in here and they don't seem to be in any logical order. There is little hope of locating the file without knowing its exact location.


Look around for any clues as to which cabinet is holding the patient file you are working on.















HTMLText_430EE33A_6380_5004_41BD_38E2F6D8B561.html =



Test 1
Serum kappa/lambda free light-chain ratio


Test 4
Serum Protein Electrophoresis (SPEP)


Test 5
Urine Protein Electrophoresis (UPEP)





HTMLText_4331B5BB_6380_7004_41C7_732EFBCF1C28.html =



Test 1
Serum kappa/lambda free light-chain ratio


Test 4
Serum Protein Electrophoresis (SPEP)


Test 5
Urine Protein Electrophoresis (UPEP)





HTMLText_4933D8F0_686D_F377_41CE_E52126D430D0.html =
Select the test to determine the type of ATTR
HTMLText_4934D8F0_686D_F377_41D1_616CE0AAD178.html =



Genetic Testing
HTMLText_493538FF_686D_F368_41D7_1AB795A126FF.html =



Genetic Testing
HTMLText_4959F04B_6855_72A9_41C4_E92D9DEDD20E.html =
Unfortunately you shouldn't be ordering that test at this stage.


A biopsy is one method of achieving the result.
However, there is a great non-invasive option available to us for this.


Please select a different test.











HTMLText_497956B7_6855_DFF9_41D0_20C5AB82F178.html =
Unfortunately you shouldn't be ordering that test at this stage.


We should first rule out AL Amyloidoses. AL requires timely treatment so a prompt diagnosis is crucial for a positive prognosis for the patient.


Please select a different test.











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Hypertrophic cardiomyopathy
HTMLText_4CD87AF1_5546_F84A_41BB_8F4E1CC50E20.html =


Pulmonary hypertension
HTMLText_4CD8FAF1_5546_F84A_41CD_96D302F958B8.html =


Infiltrative cardiomyopathy
HTMLText_4CD8FAF1_5546_F84A_41D3_0C7245EC16AD.html =


Kidney Disease
HTMLText_4CD94AEB_5546_F85E_41D2_5FED1A686DE3.html =


Pulmonary hypertension
HTMLText_4CDC5ACB_5546_F85D_41D1_843C4D5BED34.html =


Hypertensive cardiomyopathy
HTMLText_4CDC5ACB_5546_F85D_41D4_801515A5C189.html =


Hypertensive cardiomyopathy
HTMLText_4CDDDACB_5546_F85D_41B9_866816AD5A80.html =
Select the most likely cause of Ben Collin’s HFpEF diagnosis (Check all that apply):
HTMLText_4CDE2ADB_5546_F87E_41BD_97A87F8F55A0.html =


Infiltrative cardiomyopathy
HTMLText_4CDEEADB_5546_F87E_4184_B9DDE255B417.html =


Hypertrophic cardiomyopathy
HTMLText_4CDF1ADB_5546_F87E_41BE_793D9CFC6658.html =


Kidney Disease
HTMLText_5A3C465A_43FD_603B_419D_495357371960.html =
{{quiz.time.remaining}}


HTMLText_62A7FEF6_44D5_603C_41C3_7D4D735A654A.html =
Great Work



That’s it! You can now interact with objects.






HTMLText_635E0EF8_44D5_6034_41C8_01173395A4A2.html =
Cabinet B13 is Locked...


You've identified the correct cabinet, but frustratingly it appears to be locked. You’ll need to locate the key and get this filing cabinet open before you can access the file.


The key must be around here somewhere, look around and see if you can find it.













HTMLText_6BC7F04F_2BAE_7693_41C2_0BC604266DC8.html =
Great Work



That’s it! You can now interact with objects.






HTMLText_7713813B_6855_F2E8_41C4_B01B385500D1.html =



Heart Biopsy
HTMLText_774D1783_6855_3D98_41C0_D4457BE1F29C.html =



Heart Biopsy
HTMLText_777A5923_686D_3299_41C8_DC6E4A2FE37C.html =



Nuclear Scintigraphy
HTMLText_77E04FBE_6856_CDE8_41B2_11CD1EED8BE1.html =



Nuclear Scintigraphy
HTMLText_77E7FFAF_6856_CDE9_41A0_054E158F17BF.html =
Select the most appropriate test for the confirmation of ATTR
HTMLText_797479AD_6F55_6E83_4190_AB9B8C999935.html =
Have you identified the most likely cause?
HTMLText_79C23EB9_6F4D_E283_41D4_12901EF85E92.html =
You are out of time


The unexplained cases at The UCL are immensely difficult, complex and often incredibly rare (which is why they are referred here). Cases of this nature always take time to solve, so please don't feel disheartened by running out of time today. I am hoping that you still found the experience a valuable one.


You are welcome back anytime so please do take the time to retry the case in order to arrive at a diagnosis within the time limit. You can also continue from where you left without a timer.
HTMLText_7B5ADE53_6381_B0D2_41D7_1261DD36892E.html =
Select the set of tests you would like to order
HTMLText_7CC5236C_6380_B01C_4183_E20D12F867C5.html =



Test 1
Serum kappa/lambda free light-chain ratio


Test 2
Serum protein immunofixation


Test 3
Urine protein immunofixation





HTMLText_7DDC408E_6381_D01A_41D7_8B0F33695338.html =



Test 1
Serum kappa/lambda free light-chain ratio


Test 2
Serum protein immunofixation


Test 3
Urine protein immunofixation





HTMLText_9B7C9F55_B9C4_4BE5_4199_47E9D0B3F32D.html =
Welcome to the Case Room,
which, as the name suggests, is where we keep all our current and past case files.


HTMLText_A11A16F9_B9C4_DA97_41E3_549B8E8ECF7F.html =
Well hello, yes, hello and welcome.
Welcome to the Unexplained Cases Laboratory, or The UCL as we affectionately call ourselves.
HTMLText_A49C9A25_B9FC_B5A4_41CC_037AD5EEF51E.html =
Come in, come in. Welcome to The Patient Consultation Room.
Our patient has already arrived and is awaiting your examination.


HTMLText_A59742B9_B9C4_BAAC_41CE_C5C7AD830BCA.html =
That’s it! You found the patient file in our somewhat chaotic filing system.
Great work!


HTMLText_A777CCFC_B9FC_4EA5_41E2_8FE75724C1B6.html =
Welcome to the Advanced Research and Diagnosis Room here at The UCL.
In this room you'll find all of our most advanced research.
HTMLText_C92FBBE3_E8B9_4EE5_41A3_AA9DA3460771.html =
Interacting with Objects


As you explore The UCL you’ll come across numerous items and resources that may prove useful in your investigation.


You can interact with objects and even collect them in your inventory. You do this by clicking on an object while it is highlighted.


To examine the item in more detail, just select it from the bottom of the screen. We’ve made the process simple, so let’s try it together now by picking up the visitor’s pass on the reception desk.






HTMLText_C9369BE0_E8B9_4EE3_41E7_AE6FA1D384EB.html =
Great Work



That’s it! You now know how to navigate around The UCL.






HTMLText_C99B3484_EB8F_39EA_41E8_DE222EE87852.html =
Great, if you’ve got your visitor’s pass and feel confident moving around the facility then we can begin, I see our patient is already here.


When you’re ready click on the door to enter the Case Room.


And remember you have just 45 minutes to complete your work, we’re counting on you, but more importantly, so is our patient.












HTMLText_D00004EB_824F_1CC6_41D4_2806E1757BE3.html =


Obstructive Sleep Apnea
HTMLText_D00164F4_824F_1CC3_41CD_C9D88D5A8A58.html =


Obstructive Sleep Apnea
HTMLText_D12AD7D4_8245_1CCC_41C3_AD959741FC48.html =


A CPAP Machine



It looks like a new model.













HTMLText_D24D57C2_8245_1CC4_41C5_72BF0FF2222D.html =
Unfortunately you shouldn't be ordering that test at this stage.


We should first rule out AL Amyloidoses. AL requires timely treatment so a prompt diagnosis is crucial for a positive prognosis for the patient.


Please select a different test.











HTMLText_D7DC139B_824F_F546_41BA_C5E9AB400F72.html =


Obesity
HTMLText_D7DCC39B_824F_F546_41B1_A431C0393953.html =


Obesity
HTMLText_E837F2DE_E7BB_5E47_41E4_487879E39FD5.html =
Welcome to the U.C.L


*clears throat* Well hello, yes, hello and welcome.
Welcome to the Unexplained Cases Laboratory, or The U.C.L. as we affectionately call ourselves.


HTMLText_F45ADEB6_E77F_46DD_41E3_C878BAC73A78.html =
Your Role


Here at The UCL, we are sent patient files from all over the world. Patients that are often long-suffering, previously misdiagnosed or that have simply left other medical professionals scratching their heads in bamboozlement, and, simply put, we diagnose them so they can get the right treatment.


Now you might be wondering how it is, that if these patients are “undiagnosable” that we manage to successfully diagnose them. After all, our small team doesn't profess to know it all, or to be specialists in ALL medicine. Far from it.


* Points at screen* That’s where you come in.


We know that the more specialists we can involve in our cases, the more likely we are to get an accurate diagnosis. It is by tapping into a diverse knowledge pool from around the globe that our patients can benefit from the huge wealth of experience of people like yourself.


We’re absolutely delighted you have decided to lend your experience and knowledge to The UCL today, to potentially provide a diagnosis and ultimately change our patient’s life for the better.




HTMLText_F49110BC_E77B_3ACE_41C0_80F83EAFDEEA.html =
The Patient


The priority case for today is for the patient Ben Collins - a 69-year-old African-American male who, as you will soon discover for yourself, has a long and varied history of symptoms that are severely impacting his quality of life. Mr Collins has been diagnosed multiple times and received a variety of treatments in recent years, however, a multitude of symptoms remain.


Most worryingly, he got in contact last week to say that he was having progressive fatigue, shortness of breath.


I’m sure that you can agree that an accurate and swift diagnosis is essential for the future wellbeing of Mr. Collins.
HTMLText_FB9DC9A1_E889_CAF4_41C4_2B0298F53B2E.html =
Your Task


As a visiting specialist, we are asking you to lend your experience and knowledge to The UCL today, to provide a diagnosis and ultimately change our patient’s life for the better.


We, at The UCL, will provide you with everything you need to achieve this. In fact, we will grant you complete access to The UCL. Here, you can explore our lab, review Mr. Collins' complete medical history and patient file, access relevant resources and conduct a full consultation.


All patient history and data within the case file are based upon a real-world example. However, for the protection of the patient, an alias has been used.
HTMLText_FCA2277D_EC44_8824_41D1_0D87DE51E255.html =
Unlocking the Cabinet



The key fits!


The Cabinet is unlocked!




HTMLText_FCA4B78D_EC44_88E5_41D2_455186287148.html =
The Patient File


You open the drawer, knowing where the file is placed, it doesn't take you long to locate the document.


Congratulations! You have obtained the patient file!






HTMLText_FF60E753_E999_C796_41DD_F0399106A9FD.html =
Introduction to the controls


Moving around The UC, is really rather simple. Simply hover your cursor over the arrows on the floor and then click your left mouse button.









HTMLText_FF794762_E999_C7B6_41E7_1A9E7152DFB1.html =
Camera rotation & movement


To look around simply hold the left mouse button and move the mouse. Why don’t you try it for yourself right now, and when you’re happy move over to the Reception Desk.





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video_FD01AE43_B731_01E8_41E3_9CE66FCDFB87.subtitles = media/video_FD01AE43_B731_01E8_41E3_9CE66FCDFB87_en.vtt ## Popup ### Body htmlText_0BABBE90_2D39_37A4_41B5_EA9C2D5308C6.html =
Hereditary Type ATTR Confirmed
htmlText_1844994B_0F73_A862_41A1_2BC75A343DE7.html =
PLACEHOLDER
htmlText_28AB86DB_0F77_9862_41A5_52A4A802645F.html =
Smartphone - Shows a text message with an invite to an event about Nuclear / Bone Scintigraphy saying "Hope to see you there". Strapline for the event is "A new use for an old technique".



htmlText_29DC3BDD_0F13_6866_41A6_49D20A100184.html =
You keep looking but still nothing...
htmlText_2EA98DA8_0F6F_A82E_41AB_7D673358F0A3.html =
A huge pile of various books, journals and documents. I should look deeper...
htmlText_2EEE385B_0F6C_A862_4175_54EBE8317306.html =
You can't find anything usefull just yet....
htmlText_6B987397_44DF_60C9_41AF_D2FE647B3025.html =
No power...
htmlText_74065E63_44D7_2049_41A2_FB8F2E85D6B7.html =
Somebody must have accidentally hit the print button. Nothing here...
htmlText_7422716D_44D5_6059_41A2_264D3D8914EE.html =
No need for that...
htmlText_769A5CB0_44DF_E0C7_41C5_D9435FAC6CC3.html =
Somebody must have accidentally hit the print button. Nothing here...
htmlText_775CA673_44DD_204A_41C0_E97F001F63E9.html =
Common desk stuff.
### Title window_089A4B75_2D37_3D6D_41C2_4A7F9016FB93.title = Genetic Testing Results window_187B394B_0F73_A862_419A_F868D18A1BEA.title = ABOUT U.C.L ## E-Learning ### Score Name score1.label = Score 1 ### Question Screen quizQuestion_17B5B660_0F3C_985E_4198_D3CA33E15F8D.ok = OK ### Report Screen quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.completion = Completed quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.downloadCSV = Download .csv quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.elapsedTime = Time quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.items = Items Found quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.questions = Questions quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.questionsCorrect = Correct quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.questionsIncorrect = Incorrect quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.repeat = Repeat quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.submitToLMS = Submit quizScore_17880660_0F3C_985E_4198_A012E44C8D8A.title = - SCORE - ### Timeout Screen quizTimeout_17B4A660_0F3C_985E_41A3_E242F5CC2666.repeat = Repeat quizTimeout_17B4A660_0F3C_985E_41A3_E242F5CC2666.score = View Score quizTimeout_17B4A660_0F3C_985E_41A3_E242F5CC2666.title = - TIMEOUT -