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Old 03-26-2014
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Default orthostatic hypotension

50 YO HTN M C/O FALL IN MORNING AND LOSS OF CONCIOUSNESS. PT ATE SOMETHING OUT IN RESTAURANT 3 D BACK AND HAD A TRAVEL TO MEXICO 4 D BACK. AFTER THAT HE WAS VOMITTING 6-7 / D CONTAINING FOOD AND PASSING LOOSE WATERY STOOLS 3/ D CONTAINING MUCUS AND IS FOUL SMELLING. NO BLOOD IN STOOL. DIFFUSE ABD PAIN AND FEVER PRESENT.
NO SOB, CHEST PAIN OR HEADACHE.
ROS: NL EXCEPT ABOVE.
ALLERGY: NONE
MEDICATION: HCTZ AND PRAZOCIN
PH: HTN X 5 YR, BPH.
SH: OCCASIONALLY DRINKS AND NON SMOKER.

O/E SUNKEN EYES, DRY MOUTH AND DIFFUSE ABD. TENDERNESS.


What will be DD's for this case. Please give your answer for DD's in order of we should write in exam.
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Old 03-27-2014
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Quote:
Originally Posted by sherry2013 View Post
50 YO HTN M C/O FALL IN MORNING AND LOSS OF CONCIOUSNESS. PT ATE SOMETHING OUT IN RESTAURANT 3 D BACK AND HAD A TRAVEL TO MEXICO 4 D BACK. AFTER THAT HE WAS VOMITTING 6-7 / D CONTAINING FOOD AND PASSING LOOSE WATERY STOOLS 3/ D CONTAINING MUCUS AND IS FOUL SMELLING. NO BLOOD IN STOOL. DIFFUSE ABD PAIN AND FEVER PRESENT.
NO SOB, CHEST PAIN OR HEADACHE.
ROS: NL EXCEPT ABOVE.
ALLERGY: NONE
MEDICATION: HCTZ AND PRAZOCIN
PH: HTN X 5 YR, BPH.
SH: OCCASIONALLY DRINKS AND NON SMOKER.

O/E SUNKEN EYES, DRY MOUTH AND DIFFUSE ABD. TENDERNESS.


What will be DD's for this case. Please give your answer for DD's in order of we should write in exam.
orthostatic hypotension is 1 good option.
second: syncope due to arrhythmia or dehydration ( syncope=LOC less than 2 min w/o auras and post ictal state).
on work up we can write orthostatic VS.

we can see: LOC with bp high. So first r/o seizure or syncope then we have to focus on cardiac or vasovagal syncope

Last edited by romeja; 03-27-2014 at 05:54 PM.
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