QUESTION No 1 A 17-year-old male presents with a complaint of a red, itchy rash over his torso and back x 1 week, which is keeping him up at night. He denies sick exposures or a recent visit to wooded areas. He denies other symptoms, significant history, or allergies.
1-In order of importance, describe three (3) questions that you would like to ask this patient and give a brief explanation of why?
2- From the information provided, list your differential diagnoses in the order of “most likely” to “possible but unlikely.”
QUESTION No 2
An 89-year-old female complains of a “stabbing chest pain” and points to the area just below her scapula at the right mid-clavicular line. She states that she had an upper respiratory infection last week that “just seems to hang on.” She has no other complaints.
1- In order of importance, describe three (3) questions that you would like to ask this patient and give a brief explanation of why.
2- Which lab or imaging tests would you order for this patient? Why?
Expert Solution Preview
Introduction:
As a medical professor, my role involves creating college assignments and answer keys for medical college students, designing and conducting lectures, evaluating student performance, and providing feedback through examinations and assignments. In this context, I will address the questions pertaining to two clinical scenarios.
Answer to Question No 1:
1. What is the onset and progression of the rash? Understanding the temporal aspects of the rash will help determine its potential etiology. For instance, if the rash started suddenly and progressed rapidly, it may suggest an acute allergic reaction. On the other hand, if it developed gradually and has lingered for a week, it could be indicative of a chronic inflammatory process.
2. Are there any associated symptoms? Identifying any associated symptoms will aid in narrowing down the differential diagnosis. For instance, if the patient reports fever or joint pain, infective causes might be more likely. Conversely, if there are systemic symptoms like fatigue or weight loss, an autoimmune condition could be considered.
3. Have there been any recent exposures or changes in the patient’s environment? Inquiring about potential contacts with irritants, new personal care products, or changes in living conditions can provide valuable clues. For example, exposure to a new laundry detergent or fabric softener may suggest contact dermatitis as a cause of the rash.
Answer to Question No 2:
1. How would you describe the nature and intensity of the chest pain? Understanding the characteristics of the pain, such as its quality, radiation, exacerbating, and relieving factors, can help differentiate between cardiac, pulmonary, musculoskeletal, or gastrointestinal causes. Asking about accompanying symptoms like shortness of breath or diaphoresis can be useful as well.
2. Is there any history of trauma or recent injury to the chest or back? Inquiring about any traumatic events or falls aids in ruling out musculoskeletal causes of chest pain, such as a rib fracture or muscle strain. Additionally, this information helps identify any potential red flags that may require further diagnostic evaluation.
3. How has the upper respiratory infection progressed since last week? Gathering details about the duration and progression of the respiratory infection is essential in determining if there is any potential complication, such as pneumonia or pleurisy, which can cause chest pain.
2- Considering the information provided, the differential diagnoses in order of “most likely” to “possible but unlikely” for the 89-year-old female with stabbing chest pain below the right mid-clavicular line would include:
1. Musculoskeletal pain: Given the point of tenderness at the right mid-clavicular line below the scapula, it is important to consider local musculoskeletal causes like muscle strain or costochondritis.
2. Pleuritic pain: The recent upper respiratory infection can lead to pleurisy, an inflammation of the pleural lining, resulting in localized chest pain exacerbated by deep breathing or coughing.
3. Cardiac causes: While less likely, cardiac etiologies like angina or myocardial infarction cannot be completely ruled out, especially in the elderly population with comorbidities. A detailed cardiac evaluation may be warranted to exclude these possibilities.
Note: These answers are provided based on the limited information given in the questions, and a comprehensive assessment by a healthcare professional is always recommended for accurate diagnosis and management.
