Ill start with the first one
case 2 FA 21 YO WITH PAIN ABDOMEN
DDx 1: appendicitis
hx:1) acute RLQ pain 2)fever 3)N/V
PE RLQ tender, guarding, rvsing +, Psoas+
DDx 2 : PID
Hx: Multiple partners, doesn not use condoms, previous hx of std
PE: RLQ pain, vaginal spotting
DDX3 Ectopic pregnancy
Hx:LMP 5 weeks ago, vaginal spotting
PE: RLQ tenderness

so now the problem is that although we do have clues to the ddx we do not have many for the 2nd and 3rd one cause the exam findings are non contributory.... any suggestions?


WORKUP:
pelvic and rectal exam
urine B hcg
US abdomen and pelvis
cbc:scared:

 

Case 3 fa

case is pretty straight forward in terms of HX and PE.

in terms of PN writing:
FA mentions that patient anxious when asked about living conditions.(which is a must)
in terms of DDX i would go with FA DDx but in this order
1:Humerus fracture
2:shoulder dislocation
3: elder abuse

for shoulder examination do we do a drop test for this case?
also points in favor of each diagnosis are not very clear so what to mention?
in counseling the patient do we mention that we are obligated to tell protective services about this cause FA does not mention it

any inputs?

 

case is pretty straight forward in terms of HX and PE.

in terms of PN writing:
FA mentions that patient anxious when asked about living conditions.(which is a must)
in terms of DDX i would go with FA DDx but in this order
1:Humerus fracture
2:shoulder dislocation
3: elder abuse

for shoulder examination do we do a drop test for this case?
also points in favor of each diagnosis are not very clear so what to mention?
in counseling the patient do we mention that we are obligated to tell protective services about this cause FA does not mention it

any inputs?

hi. i think this is helpful info. thanks for starting this thread.
d/d
1)humerus #
his: pain in upper and middle arm, h/o fall on an outstretched hand
pe:? tendernessright shoulder., restricted ROM on flexion, extension.
2)shoudler dislocation
his:h/o fall on an outstretched hand,pain in upper and middle arm,
pe:?
3) elder abuse
his: delay in seeking treatment.
pe;?

 

FA case 4

Again I dont think taking history is that challenging in this case but ofcourse the patient has to be rude and defensive and we have to use pearls etc.

about the examination: must do HEENT including lymph nodes and thyroid exam.
CHEST and ABD

coming to PN writing:
DDX 1: IMN fever,hx in gf, sore throat for PE:LUQ tenderness, ??? dont know what else we might find on examination
DDx2:: pharyngitis: again fever, fatigue sore throat, malaise etc PE: i dont think they can reproduce a inflamed pharynx so????
DDx 3:tonsillitis is my bet cause i cant justify acute HIV since its like any viral infection

its a good case to get if there are enough PE findings to come to a diagnosis

any inputs?