Question

Sarah, a 45-year-old female presents to the outpatient office complaining of red, “itching, burning, gooey” eyes. She reports noticing discomfort three days ago after returning from a weekend vacation to a waterpark. Sarah reports trying to rinse her eyes out with contact lens solution several times yesterday, but feels this is not helping. She denies any fever or chills. She has a past history of seasonal allergies, and occasionally takes Zyrtec PRN for nasal congestion. Her last dose was yesterday. Sarah works as a teacher in a daycare center during the day, and cleans office buildings at night. She is single, and is sexually active with 3 partners in the past 6 months. She smokes ½ pack per day and takes a daily multivitamin.

Her Snellen Eye check is 20/20 with contact lenses. T98.2, BP 92/60, HR 64, RR 20

1. Highlight the pertinent information in the above case study. Use those details to form a 1-2 sentence problem statement using medical terminology and your knowledge of syndromes.

2. Highlight one of the following frameworks that you will use in creating your differential diagnoses list:

ANATOMIC     PHYSIOLOGIC      MNEUMONIC (vindicate)

Brainstorm the Differential Diagnoses List:

List the “key” pertinent positives and/or negatives for each diagnosis

Framework Category	Potential diagnoses (if more than one, separate by commas)	Key Pertinent Positives and/or Pertinent Negatives

3. Choose 5-8 of the most likely differential diagnoses and list them in order from most likely (your “working diagnosis”) to least likely. Identify your “must not miss”/” potentially deadly” diagnoses in bold.

Use your working diagnosis to answer the following questions:

1: Are there any risk factors that predisposed this patient to the working diagnosis?

2: Consider Past Medical history, Social and/or Family history- does any of this influence or support your working diagnosis? if so, explain.

2: What is the classic subjective presentation for a client who has your working diagnosis? (HPI-OLDCART-PQRST)

4: List the body systems will you need to examine based on your working diagnosis, and include the findings that would be expected in that condition.

5: What procedures, labs or diagnostic studies will you need to order to support your working diagnosis, and indicate what results would support your diagnosis.

6: Using approved guidelines from your guideline texts (Fenstermacher or Cash & Glass), establish the treatment plan for this patient. Be specific and include medications you would order, strength, frequency, length of treatment and any referrals for interprofessional care.

7: What type of education will the patient require about the diagnosis and management plan?

8: What is your follow up plan for the patient?

Answer 1

1) Eyes are red, itching and burning

- past history of seasonal allergies,

Patient may be suffering from conjunctivitis or an eye allergy. Syndrome is a disease with multiple clinical manifestation .

2) Potential diagnosis

Conjunctivitis, eye allergy, Blepharitis, stye, or due to prolonged use of contact lens, sexually transmitted diseases like erpes, gonorrhea, venereal warts, syphilis can also affect the eye and further lead to blindness

a) Risk factors which expose to eye infection are recent visit to water park, use of contact lenses, history of allergies, multiple partners

b) Eye infection usually causes pain, burning, redness, watery eyes, swollen.

c) To rule out correct diagnosis an eye examination must be done, also gynaecological examination to rule aut any sexual transmitted diseases.

d) swab of the eye secreatiins can be taken to rule out the exact infection

e) patient will be orders antibiotic eye drops like sulfacetamide solution or moxifloxacin etc and tear fresh drops to reduce the discomfort and infection

f) Instruct the patient to stop wearing contact lenses, apply some cold compress to relieve discomfort and avoid touching or rubbing eyes. As the patient to follow up is the symptoms don't decrease after 3 days.