NURS-6512 Week 3: Assignment 1 Differential Diagnosis Exercise quiz
Differential Diagnosis Exercise
The assignment this week is intended to demonstrate a method to develop a list of differential diagnosis based on a case study and then how to attach characteristics to those diagnosis to facilitate reaching a realistic working diagnosis.
The first case is an example and will demonstrate the process and information you are expected to generate for the 3 cases that follow.
This is a self-paced exercise. You will receive full credit for completion. Please carefully review the feedback to check your answers.
By Day 7 of Week 3
Complete and submit
the Differential Diagnosis Exercise. Click the
Take the Survey
button below to begin the exercise.
Score for this survey:
25
out of 25
Submitted Mar 10 at 10:41 am
This attempt took 1,001 minutes.
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:
Allergic Conjunctivitis
– Often presents with
stringy, white mucus
, itching, and bilateral involvement but can start in one eye. Common triggers include pollen, pet dander, and dust.
Viral Conjunctivitis
– Typically associated with
watery discharge
, redness, and possible recent upper respiratory infection. Highly contagious.
Bacterial Conjunctivitis: It usually
has
thick, purulent discharge (yellow/green)
with
eyelid matting
in the morning. It is often unilateral but can spread.
Dry Eye Syndrome (Keratoconjunctivitis Sicca)
– Can cause
stringy mucus discharge
, irritation, and foreign body sensation, worsened by environmental factors (wind, screens, etc.).
Dacryocystitis
–
Infection of the lacrimal sac
, causing
excessive tearing, discharge, and possible swelling near the inner corner of the eye
.
Blepharitis
– Chronic eyelid inflammation that can cause
stringy discharge, crusting of the eyelashes, and irritation
. Often associated with meibomian gland dysfunction.
Contact Lens-Related Conjunctivitis
– If the patient wears contact lenses, irritation and
mucus discharge
can result from improper lens hygiene or allergic reactions to lens solution. NURS-6512 Week 3: Assignment 1 Differential Diagnosis Exercise quiz
LET’S HANDLE YOUR CLASSWORK
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 NURS-6512 Week 3: Assignment 1 Differential Diagnosis Exercise quiz
Based on the case study and table above, what is the working diagnosis?
Your Answer:
Working Diagnosis: Allergic Conjunctivitis
Rationale:
Primary Symptoms:
The patient describes a
white, stringy discharge that is present all day
, aligning with
allergic conjunctivitis
rather than bacterial or viral causes.
No Pain or Vision Issues:
The patient denies
eye pain, foreign body sensation, or vision disturbances
, making
keratitis, foreign objects, scratched cornea, and glaucoma less likely
.
No Thick or Purulent Drainage:
Bacterial conjunctivitis typically has a thick yellow/green discharge
with eyelid crusting in the morning, which the patient does not describe.
No Watery or Mucous Discharge:
Viral conjunctivitis typically presents with watery, mucous-like discharge
and is often associated with an upper respiratory infection, which was not reported.
Chronic and Consistent Discharge:
The
persistent white, stringy drainage all day
aligns most closely with
allergic conjunctivitis
, which is characterized by
consistent
clear-to-white mucus production without significant worsening overnight.
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:
Differential Diagnosis for Chronic Nighttime Cough
Gastroesophageal Reflux Disease (GERD)
—A dry, non-productive cough that worsens at night when lying down is a classic symptom of GERD, which is caused by acid irritating the upper airway. Improvement with drinking water may also suggest this diagnosis.
Postnasal Drip (Upper Airway Cough Syndrome – UACS)
– Even though the patient denies congestion or nasal stuffiness,
silent postnasal drip
can cause irritation and a dry nighttime cough.
Asthma (Cough-Variant Asthma)
– Nighttime cough is a common symptom of cough-variant asthma, even without wheezing or shortness of breath.
ACE Inhibitor-Induced Cough—If the patient is taking
an
ACE inhibitor (e.g., lisinopril, enalapril),
it could cause a persistent dry cough, typically worsening at night.
Allergic Rhinitis
– Environmental allergens (e.g., dust mites, pet dander) may irritate, leading to nighttime coughing. The absence of nasal congestion does not rule this out.
Heart Failure (Mild or Early Stage)
– A
dry cough that worsens at night when lying flat
can indicate fluid buildup in the lungs, though the patient denies other symptoms like shortness of breath or swelling.
Habit Cough (Psychogenic Cough)
– A persistent dry cough with no apparent cause, often worsened by specific situations (e.g., lying down), may be psychogenic. NURS-6512 Week 3: Assignment 1 Differential Diagnosis Exercise quiz
Question 4
Add characteristics for each of the potential diagnoses, outlined in question 3.
Potential Diagnosis
Characteristics
Your Answer:
Potential Diagnosis
Characteristics
Gastroesophageal Reflux Disease (GERD)
Dry, non-productive cough worse at night or when lying down; may improve with drinking water; often no other symptoms or occasional heartburn.
Postnasal Drip (Upper Airway Cough Syndrome – UACS)
Sensation of mucus in the throat, throat clearing, nighttime cough, often no nasal congestion; worsens when lying down.
Cough-Variant Asthma
Chronic dry cough, typically worse at night; may not have wheezing but can be triggered by cold air, allergens, or irritants.
ACE Inhibitor-Induced Cough
Persistent dry cough that worsens at night; associated with ACE inhibitors (e.g., lisinopril, enalapril); resolves after stopping medication.
Allergic Rhinitis
Dry cough triggered by environmental allergens (e.g., dust, pet dander, pollen); may be associated with itchy eyes, sneezing, or mild throat irritation.
Heart Failure (Mild or Early Stage)
Dry cough that worsens at night or when lying flat; may have mild shortness of breath or fatigue, especially with exertion.
Habit Cough (Psychogenic Cough)
Persistent dry cough with no apparent cause; often occurs in specific situations (e.g., at night or when lying down); no improvement with typical treatments.
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:
I choose GERD has well
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:
Differential Diagnoses for Right Upper Quadrant (RUQ) Abdominal Pain
Cholelithiasis (Gallstones)
– Intermittent,
postprandial RUQ pain
, worsened by fatty foods, radiates to the
shoulder/back
, nausea, and
clay-colored stools
suggest biliary involvement.
Cholecystitis (Inflamed Gallbladder)
– Persistent
RUQ pain after eating
, nausea, and potential
radiation to the back/shoulder
. Typically associated with fever, which this patient does not have, but still a consideration.
Biliary Colic
–
Severe, crampy RUQ pain after meals
, particularly after fatty foods, with nausea and shoulder radiation; transient and resolves after a few hours.
Choledocholithiasis (Common Bile Duct Stones)
—Gallstones lodged in the common bile duct
can cause
RUQ pain, nausea, and clay-colored stools
(due to bile duct obstruction), but they usually present with jaundice, which is not reported.
Peptic Ulcer Disease (PUD)
–
Epigastric pain
, sometimes
radiating to the back
, nausea, worsened or improved by food, and may not respond well to
antacids or PPIs
(as seen in this case). Less likely, given the RUQ localization.
Hepatitis or Liver Disease
–
RUQ discomfort, nausea, and clay-colored stools
could suggest liver dysfunction, though the
sharp, crampy nature
of pain is less typical.
Pancreatitis
– Severe
epigastric or RUQ pain radiating to the back
, nausea, and worsening with fatty meals could indicate
gallstone-induced pancreatitis. However,
lack of vomiting or fever
makes this less likely.
Question 7
Add characteristics for each of the potential diagnosis:
Potential Diagnosis
Characteristics
NURS-6512 Week 3: Assignment 1 Differential Diagnosis Exercise quiz
Your Answer:
Potential Diagnosis
Characteristics
Cholelithiasis (Gallstones)
Intermittent
RUQ pain
, worsened by
fatty meals
, nausea,
radiates to shoulder/back
,
clay-colored stools
due to bile flow obstruction. No fever.
Cholecystitis (Inflamed Gallbladder)
Severe, persistent RUQ pain
, worsened after eating,
nausea
, possible
fever
,
Murphy’s sign positive
(pain with deep inspiration during palpation of RUQ).
Biliary Colic
Crampy, sharp RUQ pain after fatty meals
, nausea,
radiates to the back or shoulder
, pain resolves within hours. No fever.
Choledocholithiasis (Common Bile Duct Stones)
Severe RUQ pain
,
clay-colored stools, nausea
, potential
jaundice
, may progress to infection (cholangitis) if untreated.
Peptic Ulcer Disease (PUD)
Epigastric or RUQ pain
, can radiate to back,
nausea
, pain may improve or worsen with food, may not respond well to
antacids or PPIs
.
Hepatitis or Liver Disease
RUQ discomfort
, nausea,
clay-colored stools
, possible
jaundice
, fatigue, and
elevated liver enzymes
. Usually
not crampy or severe pain
.
Pancreatitis
Severe epigastric or RUQ pain radiating to the back
, worsened by
fatty foods
,
nausea, possible vomiting
, history of gallstones or alcohol use. NURS-6512 Week 3: Assignment 1 Differential Diagnosis Exercise quiz
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:
Cholecystits
Survey Score:
25
out of 25 – NURS-6512 Week 3: Assignment 1 Differential Diagnosis Exercise quiz