Reference no: EM133241787
Case 1:
An 18-year-old male college student presents to the clinic with a complaint of redness and pain to his right eye for 2 days. He is a longtime contact lens user, and 3 nights ago slept with lenses in. He denies any visual changes but complains of some mild photophobia.
- What specific questions would you ask in the HPI including OPQRST, ROS, PMH, PSH, SH and medications and provide rationale. What associated symptoms would you be interested in and why?
- What focused physical examination would you perform? Describe each area you would examine and why.
- Differentiate symptom complaint and physical examination for allergic, viral and bacterial conjunctivitis with rationale.
- What is your complete list of differential diagnoses with rationale? At this point, what is the leading hypothesis, what are the alternatives and is there a must not miss diagnosis? Given this differential diagnosis what tests should be ordered?
Case 2:
A 79-year-old female presents to the clinic with a c/o URI symptoms, including yellowish nasal discharge, sinus pressure and some itching to her soft palate and throat for about 4 days. About 3 weeks ago she had similar symptoms and went to a walk-in medical clinic; she was diagnosed with an " infection," and was given a prescription for Amoxicillin 500mg TID for 14 days.
- What specific questions would you ask in the HPI including OPQRST, ROS, PMH, PSH, SH and medications and provide rationale. What associated symptoms would you be interested in and why?
- What focused physical examination would you perform? Describe each area you would examine and why.
- Differentiate symptom complaint and physical examination for allergic, viral and bacterial etiologies of sinusitis with rationale.
- What is your complete list of differential diagnoses with rationale? At this point, what is the leading hypothesis, what are the alternatives and is there a must not miss diagnosis? Given this differential diagnosis what tests should be ordered?
Case 3:
Terry is a 49-year-old who complains of a pain in her head. It started a week ago, right after she hit her head on the table while playing with her dog. She had a lump on the right frontal part of her head, as well as a bruise for about 5 days. Immediately afterward, she was nauseated, but she lay down for a few minutes and the nausea subsided. However, she now has pain that is not getting any better. The pain does not radiate. It is a sharp, throbbing pain; on a scale of 1 to 10, Terry says it is a 9. At first, she took Tylenol 650 mg every 3 hours, but this did not help. Then a friend gave her some Darvocet to take, and that made the pain feel somewhat better. Terry has been taking two Darvocet every 4 hours during the day. At night she puts an ice pack on her head, which provides some relief. However, in the morning she has the pain all over again. Her friend ran out of Darvocet, so Terry has come in to get more. The pain does not bother her eyes. She does not get dizzy, nor does she have flashes of light. She does have a stiff neck on her right side. For that she uses a heating pad, which helps somewhat. She has never had this kind of pain before. She has no allergies.
- What is your complete list of differential diagnoses with rationale? At this point, what is the leading hypothesis, what are the alternatives and is there a must not miss diagnosis? Given this differential diagnosis what tests should be ordered?
Case 4:
Ray is a 45-year-old man with a vision problem. Over the last 2 years, he has noticed that he has difficulty reading something unless it is at least 2 feet away. He keeps having to stretch her arms out to read material such as menus and books. Ray is getting tired of this because his arms just don't stretch far enough. He figures his vision problem is just due to old age. He has used magnifying glasses from the dime store. He denies headache, problems with color vision, nausea, glaucoma, or cataracts (although his mother had one removed when she was 60 years of age). Both of his parents and four of his five brothers and sisters had to get glasses by the time they were 51 years of age. Ray has no disability except when he tries to paint. He had his last eye examination over 2 years ago but did not have vision problems at that time. Ray has never worn glasses previously. He works as a car salesperson.
- What is your complete list of differential diagnoses with rationale? At this point, what is the leading hypothesis, what are the alternatives and is there a must not miss diagnosis? Given this differential diagnosis what tests should be ordered?
Case 5:
Cory has right ear pain. The pain is sharp and radiates to the inside of his ear. It started after he tried to scratch his ear with a paper clip. There has also been a brownish red drainage on cory's pillow at night since this happened 2 days ago. He has applied hot packs to the right side, but that has increased the pain. He then tried cold packs, which made the pain feel better. Cory does not know if he is having trouble hearing out of that ear because it hurts too much to really tell. On a scale of 1 to 10, he rates the pain as a 9. He has also been taking Tylenol every 3 to 4 hours. Cory denies previous ear infections. His mother used a bobby pin to clean her ears, so Cory thought that a paper clip could be used to scratch his ear.
- What is your complete list of differential diagnoses with rationale? At this point, what is the leading hypothesis, what are the alternatives and is there a must not miss diagnosis? Given this differential diagnosis what tests should be ordered?