Transcript of PBL tape: Episode "My Theory" [T. Koschman et al. data]

PBL Analysis paper

Note: The format of the original transcripts supplied to me does not seem to translate well into HTML and the line numbers are lost, so I have re-inserted a number for every 10th line below. In the original transcipt note that emphasis, ligature, and low voice or unclarity are not marked, but that the open bracket symbols indicate overlaps to speech in the next line(s). Numbers in parenthesis indicate lengths in seconds of significant pauses.

Coach: So he's got speech involvement 'n ---------------------1
right leg involvement.
Maria: (Speech involvement)
Coach: So- So whatever
problem is: (.) we're pretty
confident it's on the left side.
(1.7) ---------------------------------------------------------10
|0:20:12:20|Betty: See, what it said here
n-my theory about this
|0:20:15:00|(?): khu-hhhh

|0:20:15:00|Betty: amnesic (.) dysnomic aphasia?
(0.6) um it says the cause of lesion
is usually deep in temporal lobe
just like Maria was saying
Presumably interrupting
connections of sensory speech areas
with the hippocampal and -----------------------------------20
parahippocampal regions.
and I think the hippocampus is like
a lot more medial so if it was
affecting that area it might be the
anterior cerebral circulation.
|0:20:33:00|Norman: Anterior.
|0:20:35:00|Coach: Where is the hippocampus.
|0:20:37:00|Betty: I don-do we have a picture up there
on the -----------------------------------------------------30
|0:20:38:00|Norman: It's right down there, it's
the bottom of this thing.
(2.5)((Walks over to chart,
Right in here.
|0:20:45:00|Maria: I think it's un:der that.
|0:20:45:00|(Jenny): (I can't remember)
|0:20:47:00|Norman: It's under that?
|0:20:48:00|Maria: I think it's on the inside. ---------------40
|0:20:49:00|Coach: It's on the middle, (0.7) middle
|0:20:52:00|Maria: Sts-lk-if you lift (("lifting"
gesture with r. arm, elbow out) up
that little temporal lobe, it's on
the inside.
|0:20:55:00|Coach: You can you can point it
on the middle top.
|0:20:57:00|Maria: Middle top? --------------------------50
|0:20:58:00|Coach: Mm-mmm.
|0:21:01:00|Maria: ¡Ye:ah its,¡
|0:21:04:00|Lill: In here? ((points to chart))=
|0:21:05:00|Maria =Yeah, yeah
[ [
|0:21:05:00|Norman: [ yeah
|0:21:06:00|Coach: That's it (0.2) tha:t's the
hippocampus,then you go over one
more gyrus and you're ----------------------------------60
in the temporal lobe.
|0:21:10:00|Maria: ¡Ri:ght¡
|0:21:11:00|Coach: So you can also see it on
the (0.6) frontal.
Coach: No (you can find it)
on the second row left from there
|0:21:21:00|Norman: Hh hh hh
|0:21:24:00|Coach: Where would it be in that section.
|0:21:26:00|Lill: ¡Somewhere in here?¡ ((pointing))
(1.5) -----------------------------------------------------70
|0:21:29:00|Coach: Th:at's white matter.
|0:21:31:20|Maria: ¡In that crevice?¡
|0:21:33:00|Norman: Go to the crevice
(1.0) ----------------------------------------------------80
Norman: That little loop?
Norman: Yeah.
|0:21:37:00|Coach: That's it.
|0:21:38:00|Betty: My other theory is that if it was-
i- i- if it's not a vascular lesion
but a space occupying lesion if it
right there((points to chart)) in ----------------------------90

the area we were pointing to it
would be like in a posterior limb of
the internal capsule which would be
where (.) the cortical spinals to the
leg would be going through that
|0:21:53:00|Maria: Wouldn't you expect to see a lot=
|0:21:53:00|Norman: khh
hh huh hh hh hh ----------------------------------------------100
|0:21:53:00|Coach: Whoa kay
|0:21:53:00|Maria: greater involvement if you
Norman: hh hh
Norman: Yeah
|0:21:59:00|Maria: internal capsule?
|0:22:00:00|Betty: If it's
|0:22:02:00|Betty: If it's small. >I mean if< it's in ---------------110
the very posterior li:mb,(.)
posterior part of the posterior
li:mb.(1.0) Because there's a-the-
(2.0) somato graphic whatever
that word was,(.) arrangement of
the cordal spinals as they go
(?): ¡right¡
through the (internal) capsules.
[ -------------------------------------------------------------120
(?): Yeah
Betty: If you get way to the posterior
^part of the internal capsule the only
thing there is motor and it's
Norman: motor
Betty: going to be the le:g.
|0:22:19:00|Norman: motor
Norman: That's true
(3.0) -------------------------------------------------------130
|0:22:24:00|Coach: So why do the leg findings go
|0:22:27:00|Betty: That's a good question.=That kind
of goes against it being some
kind of a space occupying lesion
because you would expect it to get
progressive and then (you want it)
to involve more areas.
(0.4) --------------------------------------------------------140
Betty: So then it's probably=
|0:22:35:00|Maria: Headaches,=
|0:22:35:20|Betty: =more likely
|0:22:36:00|Maria: =you would expect
|0:22:36:15|Norman: You'd expect to have headaches
|0:22:37:00|Betty: ¡Maybe, yeah.¡
|0:22:38:00|Maria: Seizures.
|0:22:41:00|Betty: Um (0.8) it's more likely to be
vascular. ------------------------------------------------------150
|0:22:45:00|Coach: ¡Okay¡
|0:22:46:00|Maria: ¡With his history and social¡
|0:22:46:15|Coach: So
|0:22:48:00|Coach: So if it's vascular did he have a
+stroke or is he having a TIA. What
is the difference between those two
things anyway.
|0:22:53:00|Norman: With TIA's, it's like twenty-four
hours -----------------------------------------------------------160
|0:22:55:00|Jenny: TIA's well, a+ccording to
Harrison's TIA's um
shows some neurological damage but
it's all better in twenty-four
hours. According to Cecil's it's all
better in one hour um a hh hh hh
|0:23:09:00|Lill: (one
of 'em)
|0:23:11:00|Jenny: and Cecil's also talked about
something called RI:ND (.)which is a ------------------------------170
reversible icschemic(1.6)
neurological deficits?=
|0:23:16:00|Norman: neurological deficits
|0:23:16:00|Coach: neurological deficits
|0:23:19:20|Jenny: =which is somewhere in between a
completed stroke and TIA. Which, hh
huh huh=
|0:23:25:00|Betty: So like angina or unstable angina
|0:23:26:00|Jenny: Hh huh huh huh ----------------------------------180
|0:23:27:00|Betty: the mind.
|0:23:29:00|Jenny: =which um gets better within
twenty-four to thirty-+six hours,
um,(1.2)((Lips smack then mouths
something like 'I don't know'))
|0:23:38:00|Coach: So which one did he ha:ve?
|0:23:40:00|Jenny: ¡M [m¡
|0:23:41:00|Maria: I think he's (.)progressing to a
|0:23:41:10|Norman: >A little bit of -------------------------------------190
|0:23:43:00|Maria: stroke.
|0:23:43:20|Betty I think it's really hard to say
because I don't think we have a
very good history [about exactly
what's happened in the last three
weeks. And I don't know how we
can im+prove that.
|0:23:50:00|Jenny: We don't know how long his [leg
was clumsy -------------------------------------------------------------200
|0:23:53:00|Betty: The leg was(clum)
|0:23:54:00|Norman: Yeah, we don't know how
long it was clumsy, It's gone now
yet he still has the +vocal problem.
|0:23:59:00|Betty: He doesn't have +any memory
[ ]
|0:23:59:00|Norman: (so )
|0:24:00:00|Betty: problem right now.= -----------------------------------210
|0:24:01:00|Norman: =Yeah, which is very o:dd.
|0:24:02:00|Betty: Based on our
mental +status exam,
|0:24:04:00|Coach: ¡Hm mm¡
|0:24:05:00|Betty: But yet his wife says that he's
periodically gets goofy or
>whatever it was that she said<
|0:24:11:00|Betty: So, ---------------------------------------------220
|0:24:13:00|Maria: See a stroke can develop over a
period of several [days usually
progressing in a step like
|0:24:18:00|Norman: =(Unless it's )
|0:24:19:00|Maria: With a deficit being added from
time to time.
|0:24:23:00|Norman: But then you would think the leg
would b'getting worse.---------------------------------------------- 230
|0:24:25:00|Norman: oI would think.o
|0:24:26:00|Maria: We:[ll it could- I mean usually
strokes are preceded by TIAs.
|0:24:32:00|Norman: Yeah
|0:24:32:10|Maria: So then
it could've just been you know
[ ]
|0:24:32:20|Norman: Well I mean that's a yeah=
=that's a risk factor +for em. -----------------------------------------240
|0:24:35:20|Norman: The thing is that (1.0) we're
seeing an- an acute leg deficit and
now (.) we're seeing five over five
|0:24:43:00|Maria: Hm-mm
|0:24:43:20|Norman: What +happened to it
|0:24:45:00|Betty: obviously there's no-
|0:24:45:00|Maria: TI+A ----------------------------------------------250
|0:24:47:00|Betty Uh it's most likely there was no
permanent damage from what=
|0:24:49:00|Maria: Right.
|0:24:50:10|Betty: had happened.
|0:24:50:22|Norman: But wh:y is his +speech now
screwed up.
|0:24:53:00|Betty: Is it screwed up
|0:24:54:00|Norman: It's screwed up +somehow
|0:24:55:00|Betty: ¡a little bit¡(hand gesture)------------------------- 260
|0:24:56:00|Norman =<like it wasn't before>
|0:24:57:00|Maria: He says it's
gotten worse in the last couple of
|0:24:59:00|Norman: =Ye:ah.
|0:24:59:00|Maria: Some:thing's gotten worse I
assume it's [his speech.
|0:24:59:00|Betty: But yet when we--
|0:25:02:00|Betty: But yet when we actually examine
him I mean occasionally not even ------------------------------------270
very often >he has trouble finding
the right word and we do a mental
status exam<(1.3) rarely >does he
have trouble finding the right word
and he can complete the +rest of
the mental status exam with no
|0:25:17:00|Betty: So I don't kno:w.
(7.0) ((Norman, Jenny looking at -----------------------------------280
|0:00:00:00|Betty: I think would prob'ly lean more
towards (1.0) trans- something
transient that comes'n goes 'n we're
catching him at a fairly good
|0:00:00:00|Maria: Uhh
|0:00:00:00|Norman: Unh:::::::::::::(("doubt"
noise)) ------------------------------------------------------------290
[ ]
|0:00:00:00|Betty: But I don't know.
|0:00:00:00|Betty: An' it seems like to me that
for(.) for: his wife to have been
concerned about whatever was going
on it has to be worse than it is
right now. Cause it's just- (.)
unless we just (.) don't have a very
clear picture of what he's really
like. Things just don't seem very ------------------------------------300
|0:00:00:00|Maria: Yeah see I don't think we have a
clear- [
|0:00:00:00|Norman: I don't see it
either. [
|0:00:00:00|Betty: I
don't know how we can fix that.
|0:00:00:00|Betty: 'Cept if we asked every question in -----------------310
the book. [
Hmm ((smile))
|0:00:00:00|Norman: ((smile))
|0:00:00:00|Betty: Hu huh huh hh.
|0:00:00:00|Coach: Some patients are vague,
|0:00:00:00|Betty: Yep.
|0:00:00:00|Coach: Don't give you the answers you
wanna hear. -------------------------------------------------------------320
|0:00:00:00|Betty: We talked to the wife right?
((looking at coach))
|0:00:00:00|Coach: Yeah
|0:00:00:00|f: ehhh ( )
|0:00:00:00|Coach: Well why wha- what's causes the
strokes. (2.0) ((Coach looks
around table, ending at Betty))
|0:00:00:00|f: ( )
|0:00:00:00|Coach: or the TIA's
( ) 330
|0:00:00:00|Norman: ((mumbling, perhaps reciting)) (
---sporosis ( developing)
Those are prob'ly two () major (.)
sources we can come up with at this
point. --------------------------------------------------------------------335