LifespanActivity Time: 29 min
Tina’s three-year-old neighbor presents to the clinic with fever, neck pain, headache, and confusion. He has no symptoms of an upper respiratory infection. The parents mention that they do not believe in immunizations. Based on the information given, what diagnosis is of the greatest concern? What is your next action?
Student Response: the neighbor has xxx, bacterial meningitis should be ruled out because immunizations put one at an increased risk for meningitis from Haemophilus influenza type B. It is important to note xxx, has no history of chronic infection. Children presenting with strep throat will have neck pain and fever, however, they are oriented and not confused, and therefore, this three-year-old patient will need an immediate spinal tap that will help in determining the nature of meningitis and will be started on a broad spectrum of antibiotics and because this is an emergency, he should be taken to an emergency room where he can get immediate care.
Model Note: Bacterial Meningitis needs to be ruled out immediately. He has not had immunizations which puts him at increased risk for meningitis from Haemophilus influenzae type B. Seizure disorder does not cause fever. Children with immunodeficiency syndrome are at increased risk for meningitis but this child has no previous history of chronic infections. Although children with strep throat can present with fever and neck pain, they are not confused. He needs an immediate spinal tap to determine the nature of the meningitis, and broad spectrum antibiotics should be started as soon as possible. He should be sent to the emergency room.
Tina’s 83-year-old great uncle forgets where he is during his yearly check-up. He doesn’t remember if he’s had memory problems before and no family members came to your office with him. List your differential diagnosis. What assessments would you perform?
Student Response: Dementia, electrolyte imbalance, stroke, infection, transient ischemic attack dehydration, and xxx differential diagnoses for this patient and therefore, a healthcare provider attending to him should conduct a neurological assessment that will help in ruling out transient ischemic attack and dementia. additionally, mucus membrane visualization and skin assessment for tenting will be done to help rule out dehydration while urinalysis will be performed to help in ruling out urinary tract infection which is a known common cause of confusion among elderly patients. More information about the patient will be needed and therefore, he will be asked some questions about his medication to check his memory and obtain information and if he is completely disoriented, his immediate family members will be used to obtain the required information.
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Model Note: Differential diagnosis includes stroke, transient ischemic attack, dementia, infection, electrolyte imbalance, dehydration and drug toxicity. The provider should do a neurological assessment to rule out stroke and TIA. Visualization of mucous membranes and skin assessment for tenting is indicated to rule out dehydration. A urinalysis should be performed to rule out a urinary tract infection which is a common cause of confusion in the elderly. He should be asked questions about his medication intake and medical history in case he retains some memory. If he is completely disoriented, family members should be contacted, if possible, to gain more information.
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