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Diagnosing and Treating Charlie’s Strange Spots


Joseph D. Shih
Natural Sciences and Mathematics
University of Saint Mary


This case study introduces a patient who comes into a doctor's office with an interesting set of symptoms that leads to an exotic cancer diagnosis. The case provides students with an opportunity to identify and classify patient information (signs, symptoms, history, etc.), explore online medical literature, construct and justify a differential diagnosis, evaluate diagnostic tests, and debate the benefits and risks of various cancer treatment options. The story is drawn from a real-life scenario, although certain details have been modified to preserve anonymity. The case was originally developed for an upper-level undergraduate immunology course for pre-health students who have taken cell biology as a prerequisite. It is suitable for any upper-level undergraduate pre-health (pre-med, pre-nursing, medical laboratory science) or first-year graduate health (physician assistant, medical, nursing, etc.) course in which clinical case studies are appropriate and cancer is a potential topic, such as immunology, clinical immunology, physiology, or pathophysiology.

  • Identify and classify information that would help a medical professional conduct a medical diagnosis.
  • Explore online medical literature and health information to determine trustworthy and untrustworthy sources.
  • Construct a differential diagnosis and justify why different diseases are more or less likely to occur based on the signs/symptoms identified.
  • Critically evaluate key tests that can be used to narrow a diagnosis.
  • Critically debate the benefits and risks of various current cancer treatments.
Keywords: Symptoms; signs; medical history; diagnosis; differential diagnosis; diagnostic tests; treatment options; cancer; chemotherapy; biopsy; Karposi’s sarcoma; Karposi sarcoma; HIV
Topical Area: N/A
Educational Level: Undergraduate upper division, Graduate, Clinical education
Formats: PDF, PowerPoint
Type/Method: Analysis (Issues), Dilemma/Decision, Directed, Discussion
Language: English
Subject Headings: Biology (General)   Cell Biology   Medicinal Chemistry   Genetics / Heredity   Medicine (General)   Microbiology  
Date Posted: 3/7/2019
Date Modified:
Copyright: Copyright held by the National Center for Case Study Teaching in Science, University at Buffalo, State University of New York. Please see our usage guidelines, which outline our policy concerning permissible reproduction of this work.

Teaching Notes

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Answer Key

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Supplemental Materials

The PowerPoint presentation below is targeted to upper-level undergraduate courses; it introduces a degree of simplicity by organizing major signs and symptoms of the patient and can be used to facilitate classroom discussion as described in the case teaching notes.

  strange_spots.pptx (~4.4 MB)

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