Differential Diagnosis Exercise

Differential Diagnosis Exercise 

Question 1

CC – “I have drainage from my eye”

HPI – 26 year old female complains of drainage from her right eye that started 3 days ago and has gotten worse.  She describes the drainage as white and stringy.  She notices the drainage all day long  and is quite bothersome to her.  She has tried Visine but it has not made it any better. Nothing specific seems to make it worse.  She denies any fever, eye pain, or feeling like there is anything in the eye.  Denies any difficulty with her vision.  The amount of drainage is significant utilizing one Kleenex an hour to absorb it.

Based on the Case Study – generate 5-7 potential diagnosis based on the patient complaints.

Your Answer:

Risk for injuring

Risk for infection spread
 
– 

Disturbed body image related to eye drainage
 

Anxiety related to unknown cause of eye drainage
 

Fear of unknown

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Question 2

For Question 1, you should have outlined the following potential diagnosis:

Bacterial conjunctivitis

Viral Conjunctivitis

Allergic Conjunctivitis

Keratitis (inflamed Cornea)

Blocked Tear Duct

Foreign Object in the Eye

Scratched Cornea

Glaucoma

Now that you have a list of potential diagnosis utilize your knowledge of each condition to identify common symptoms / characteristics to narrow down the list.

 

Potential Diagnosis

Characteristics

Bacterial conjunctivitis

Thick yellow or green drainage.  Eye lid can be stuck in the morning with crusty colored drainage

Viral Conjunctivitis

Drainage is watery, mucous like, eye lid can be stuck in the morning with clear drainage

Allergic Conjunctivitis

White or pale yellow stringy drainage, consistent

Keratitis (inflamed Cornea)

Red eye, difficulty with vision, eye pain,  sensitive to light

Foreign Object in the Eye

Complaints of something in the eye – clear drainage

Scratched Cornea

Clear drainage (tear like),  pain in the eye

Glaucoma

Watery eyes, decreased vision, eye pain

 

Based on the case study and table above, what is the working diagnosis?

 

Your Answer:

Allergic Conjunctivitis ;  White or pale yellow stringy drainage, consistent

Differential Diagnosis Exercise Question 3

For Question 2, you should have determined the working diagnosis is allergic conjunctivitis. Now, let’s move on to Student Case #1:

CC: “I have a cough”

HPI – 36-year-old female complains of a cough.  The cough started about 3 weeks ago and occurs nightly, it is non-productive and dry and occurs mostly at bedtime.   She feels fine and then goes to bed and starts coughing.   She gets up for a drink and it gets better but then gets worse when she lays down again. She has not tried any medications or treatments.  Nothing seems to make it better or worse.  She denies any wheezing, congestion, nasal stuffiness, or aching.

Generate a list of 5-7 potential diagnosis.

Your Answer:

Gastroesophageal Reflux Disease

Asthma

Hay Fever

COPD

Pneumonia

Pertussis

Question 4

Add characteristics for each of the potential diagnoses, outlined in question 3.

Potential  Diagnosis

Characteristics

 

 

 

 

 

 

 

 

 

 

 

 

Your Answer:

Asthma : Wheezing, coughing especially at night

GERD: Non productive dry cough, coughing after eating or lying down.

Hay Fever : Watery eye, sniffing, chronic  non productive cough

fatigue.

Pertussis: Running nose, Mild to severe coughing

Pneumonia : fatigue, cough, SOB sweating.

Question 5

Here are some potential diagnosis and characteristics to compare to your answers:

Diagnosis

Characteristics

Bronchitis

Symptoms throughout the day, wheezing, chest tightness

Asthma

Coughing, wheezing, chest tightness, Consistent symptoms day / night

Pneumonia

Productive cough, fever, wheezing, symptoms day / night

Cold (virus)

Nasal congestion, achy, consistent symptoms through the day / night

Allergies

Sneezing, runny nose, wheezing, itchy eyes  Consistent symptoms through the day / night

Gastroesophageal reflux disease (GERD)

Cough starts when laying flat, no wheezing, nigh time symptoms (positional)  non productive

 

The mostly likely working diagnosis would be GERD.

How did you do?

Your Answer:

Very well

Differential Diagnosis Exercise Question 6

CC: “I have pain in my abdomen”

HPI – 56-year-old male complains of pain in his abdomen that started about a month ago. He states the pain comes and goes and is usually worse after meals. He points to his right upper abdomen for the location of the pain. He has some nausea but no vomiting. He describes the pain as severe, sharp, and crampy after eating and radiates into the shoulder and back. He denies any bloating or diarrhea. His stools have been a clay like color recently. He denies any fever or chills. Eating bland food seems to make the pain better. He has tried antacids and omeprazole without much effect. The worse pain was rated a 9 after a meal of cheeseburger and fries.

Generate a list of 5-7 potential
diagnosis related to this case.

Your Answer:

Acute cholecystitis

Gallstones

Appendicitis

Bowel obstruction,

Diverticular disease

Liver or Pancreases issues

Gastritis

Question 7

Add characteristics for each of the potential diagnosis:

Potential Diagnosis

Characteristics

 

 

 

 

 

 

 

 

 

 

 

 

Your Answer:

Diverticular disease: Pain in the upper stomach.  White or pale stool

Appendicitis:  A dull ache around the belly bottom that can radiate to the upper stomach

Gallstones:  Intense pain in the upper right stomach, fatigue, vomiting

Liver or Pancreases issues: Untreated block biliary duct causing pain in the liver, inflammation

Bowel Obstruction :  Constipation, difficult digesting and absorbing food , intense pain

Gastritis:  Swollen stomach lining  and pain, allergies, NSAID

Question 8

Compare your answers to these:

Potential Diagnosis

Characteristics

Pancreatitis

Pain worsens after eating, pain radiates to back / chest, swelling / tenderness of abdomen, diarrhea, fluid build up in the abdomen, no change in the color of the stool

Appendicitis

Pain usually starts periumbicular and then moves to right lower quadrant, fever is late sign,  nausea / vomiting,  pain usually not related to meals,  increase pain with cough or ambulation

Peptic Ulcer Disease

Dull pain or burning in upper abdomen,  nausea / vomiting, bloating, belching, heartburn, pain worsens after eating, black or bloody stools

Cholecystitis

Pain worsens after eating, pain radiates to back / chest,  color change in stools,  nausea / vomiting,  bloating

Kidney Infection

Pain is located more in the CVA, pain not related to meals, usually fever associated, not as common in men

Hepatitis

Pain or bloating in the belly, nausea/vomiting, fatigue, jaundice, dark urine, pale stools, diarrhea,

The working Diagnosis: Cholecystitis

How did you do?

Your Answer:

Fair

Differential Diagnosis Exercise Survey Score:
25
 out of 25