Question

Read the patient case studies below. List 3 differential diagnosis for each and why you believe these to be solid options that should be considered by the provider. Copy and paste the patient scenarios into a word document and use bullet points below each patient for your differential diagnosis, and then upload the assignment. Below is an example.

Patient X: 7-year-old Hispanic male with a cough and temperature of 99.9F.

• Differential Dx:
  • Allergic rhinitis
  • URI
  • Pneumonia

Patients

Patient 1: 28-year-old woman with opioid use disorder; uses IV heroin; has PTSD; no other medical problems or medications. She currently is single, lives with several roommates, and has a history of legal problems (with some jail time). Sexually active with men and women; inconsistent use of protection.

Patient 2: 70-year-old man with a history of CHF, COPD, and HTN; currently smokes one pack of cigarettes daily; takes Lisinopril, Digoxin, and Symbicort daily. Married to wife of 30 years and is retired (previously an accountant), is supported by adult children, and lives with his wife at home.

Patient 3: 40-year-old woman with a history of breast cancer that was successfully treated with Tamoxifen for several months. Otherwise healthy, with no other issues at this time. She is a successful businesswoman in a high-profile career with much stress. Married to wife of four years; relationship is rocky at times. Denies any substance use; travels frequently.

Symptoms are the same for all 3 patients:

• Shortness of breath
• Chest pain
• Flank pain
• Fever

Answer 1

Patient 1: 28-year-old woman with opioid use disorder; uses IV heroin; has PTSD; no other medical problems or medications. She currently is single, lives with several roommates, and has a history of legal problems (with some jail time). Sexually active with men and women; inconsistent use of protection.

answer3:The differential diagnosis with the reasonings are as below:

• A]. {lower lobar ]Pneumonia:
• explanation :Pneumonia is common in intravenous drug users on account of respiratory depression effect of the drugs,increased risk of aspiration due to altered consciousness and immunocompromised status due to poor nutrition ,self neglect or acquired HIV. The common organisms causing pneumonia are Streptococcus pneumoniae, klebsiella pneumoniae, Haemophilus influenzae and staphylococcus aureus,The pneumonia explains the shortness of breath and chest pain and fever and the lower lobe pneumonia often causes pain referred to the abdomen or the flank pain. Hence the symptoms associated with the flank pain point to a lower lobe pneumonia.
• B} Heart failure and glomerulonephritis/splenic abscess/liver abscess associated with Complicated infective endocarditis:
• explanation:High incidence of glomerulonephritis is reported along with infective endocarditis in intravenous drug users due to infection with staphylococcus aureus,streptococcus and other skin commensals. Heart failure and glomerulonephritis/splenic abscess/liver abscess are the common complications associated with infective endocarditis The heart failure and infective endocarditis explains the shortness of breath, chest pain and fever . Glomerulonephritis explains the flank pain .Other complications associated with infective endocarditis like liver abscess /splenic abscess can also contribute to flank pain and must be considered as the differential diagnosis in this case .

• C)Pulmonary tuberculosis along with tuberculous abdomen:
• explanation:The tuberculosis disease is very common in the intravenous drug users and may or may not be associated with an HIV infection and may occur due to nutritional and immune compromise,.Pulmonary tuberculosis explains the shortness of breath and chest pain and fever.It causes fibrocavitary lesions in the lung and may also be associated with the pneumonitis or miliary lesions.The associated extrapulmonary forms of tuberculosis ,abdominal tuberculosis/tuberculous ascites can cause mesenteric lymphadenopathy and flank pain

Patient 2: 70-year-old man with a history of CHF, COPD, and HTN; currently smokes one pack of cigarettes daily; takes Lisinopril, Digoxin, and Symbicort daily. Married to wife of 30 years and is retired (previously an accountant), is supported by adult children, and lives with his wife at home.

answer2:The differential diagnosis with the reasonings are as below:

• A}lower lobar pneumonia:
• explanation:The pneumonia explains the shortness of breath and chest pain and fever and the lower lobe pneumonia often causes pain referred to the abdomen or the flank pain. Hence the symptoms associated with the flank pain point to a lower lobe pneumonia
• B]Congestive cardiac failure with pulmonary embolism:
• explanation:The shortness of breath chest pain and fever occur due to the pulmonary embolism which is a known complication in congestive cardiac failure and the flank pain is caused by the abdominal distension and bloating .liver capsule distension in the patients of congestive cardiac failure due to fluid retention
• C]Constrictive Pericarditis with /without pericardial effusion:
• explanation: Constrictive Pericarditis can be caused by bacteria or viruses .It is also a complication post myocardial infarction, The shortness of breath ,chest pain and fever explain the pericarditis. There is abdominal distension, hepatic capsular distension and abdominal ascites with fluid retention in Constrictive Pericarditis due to poor cardiac contractility which explains the flank pain.

Patient 3: 40-year-old woman with a history of breast cancer that was successfully treated with Tamoxifen for several months. Otherwise healthy, with no other issues at this time. She is a successful businesswoman in a high-profile career with much stress. Married to wife of four years; relationship is rocky at times. Denies any substance use; travels frequently.

Symptoms are the same for all 3 patients:

• Shortness of breath
• Chest pain
• Flank pain
• Fever
• answer3:The differential diagnosis with the reasonings are as below:
• A]lower lobar pneumonia:
• explanation:The pneumonia explains the shortness of breath and chest pain and fever and the lower lobe pneumonia often causes pain referred to the abdomen or the flank pain .Hence the symptoms associated with the flank pain point to a lower lobe pneumonia
• B}Pulmonary embolism with inferior vena cava thrombosis or renal artery thrombosis (renal infarction)
• explanation:patients on long-term tamoxifen therapy are predisposed to Deep venous thrombosis. The shortness of breath ,chest pain and fever explain the pulmonary embolism while the flank pain can be explained by the complications of inferior vena cava thrombosis or renal artery thrombosis causing renal infarction and pain.All these are complications of long term tamoxifen use.
• C] Constrictive Pericarditis with /without pericardial effusion :
• explanation:Constrictive Pericarditis can be caused by bacteria or viruses .It is also a complication post myocardial infarction, The shortness of breath ,chest pain and fever explain the pericarditis. There is abdominal distension, hepatic capsular distension and abdominal ascites with fluid retention in Constrictive Pericarditis due to poor cardiac contractility which explains the flank pain.