Mystery Disease #2 Note – you are not limited to these spaces. You can expand as

Question

Mystery Disease #2

Note – you are not limited to these spaces. You can expand as much as needed.

Context:

Betty G. presents with fatigue, lethargy and overall malaise. Her father states that she has been very lethargic and weak with very little appetite. Due to that she has been losing weight. Betty G. has also complained of her joints hurting (although Dad attributed this to a recent growth spurt). Her father also noticed that she has been running a fever for a few weeks along with an accompanying rash.

VS: BP 127/83, PULSE 86, RR 10, T 100F, BMI 17, WEIGHT 86

ROS (Review of systems):

When doing a review of systems we have a methodical way of organizing the patient’s complaints and obtaining better detailed information. Questions should be asked starting with general constitution and working from head to toe.

Section 1: (Red are patient/guardian responses and pertinent information – DO NOT ADD YOUR OWN)

Starting with general constitution:

Tell me more about how you are feeling. I am tired a lot. And my knees hurt. It is hard to play outside and run around.

To Father: When did you notice this starting? I guess about 4 months ago. She just didn’t want to go outside and play which is not like her.

How much weight has she lost? About 5 lbs, which is unusual because she has a good appetite.

When did you start noticing the rash? ~2 weeks ago. I thought it was viral and would go away.

Are her immunizations current? Yes.

ASSESSMENT:

GENERAL: 11 year old white female, alert and oriented x3 (A&O x3), acute distress (AD) in joint mobility, articulate and engaging, well groomed.

HEENT (head, eyes, ears, nose, throat): Normocephalic without evidence of trauma, PEERL (Pupils equal and reactive to light), mucous membranes slightly opaque and sticky. Neck supple has slight lymphadenopathy (swollen lymph nodes), no thyromegaly (goiter or enlarged thyroid) or carotid bruits (noisy carotid pulse) observed.

LUNGS: Clear to auscultation (CTA) bilaterally throughout

CARDIOVASCULAR: Heart rate regular w/out murmurs, rubs, gallops (HRR, w/out MRG’s), S1S2 intact. 2+ peripheral pulses bilaterally. Extremities w/out edema, clubbing, cyanosis

ABDOMEN: Central tender, with palpated splenomegaly and hepatomegaly, normal bowels sounds throughout

Skin: Petechiae present systemically

Knowing this information, what 5 other specific questions would you ask? (5 points)

Remember to frame the questions correctly. For example – if it is a minor, many of the questions should be addressed to the parents.

Section 2 Labs (2 parts): Part 1 - (10 pts) This explains how you will continue your work-up with other commonly applied tests. You need to describe specifically what the tests will analyze and if there is anything in particular in that test that pertains to the situation.

Here YOU will provide the tests to be done that are routine, describe what they test for and include their normal range. You can use the example as a template. However, do not make up results. Just tell me what you will do, why and how.

Part 2 - List your findings so far (10 points): (This is not because I want you to regurgitate what is already written. This is an important exercise because it forces you to go over in DETAIL all information in the case. Therefore, this section needs to be detailed because it is the subtleties between symptoms and the patient history that give you the important clues to correctly diagnose the patient. Also you want to correctly report these to the doctor so she/he has all the information in formulating an appropriate approach to treatment). Also if lab results are given, you will describe in this section, what is different from normal or how it differs.

Explanation / Answer

GENERAL, CONSTITUTIONAL

Recent weight loss..........Yes (5 lbs)

Fever..........Yes

GASTROINTESTINAL

Abdominal pain..........

Heartburn..........

MUSCULOSKELETAL

Joint pain or swelling..........Yes

Musculoskeletal pain..........No

SKIN & INTEGUMENTARY

Rashes..........Yes

Sores..........No

ENDOCRINE

Heat or cold intolerance..........No

Excessive thirst..........No

HEMATOLOGIC/LYMPHATIC

Abnormal bleeding..........No

ALL/IMMUNE:

Allergic reaction..........Yes

Recurrent infections..........Yes

Tests

Physical examination

lipid screening - Amount of lipid level

complete blood count - Haemoglobin levels, RBC and WBC count

thyroid tests - To identify secretions and function of thyroid gland which controlls metabolism

urinalysis - To identify the color of urine and abnormal constituents

electrocardiography andchest radiography - Heart rate and rhythm

Skin test- Allergy

Liver function tests - albumin, AST, ALT and bilurubin count

X-Rays - joints

Magnetic Resonance technique

CT Scan

Ultrasonography

SYMPTOMS AND PATIENT HISTORY

Lethargy, fatigue, malaise indicates the weakness, discomfort which has caused decreased apetite. Patient has lost a weight of 5 lbs in 2 weeks. Fever associted with skin rashes and an increased number of leukocytes. Joint pains also observed which leads to inactive life style of the patient.

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