Question

Please Write Succinct:  Syncope

• Review of Systems: Associated symptoms and Risk Factors
• Findings on Focused Physical Ex
• Five Differential Diagnosis

See example below for question #1:

1. Sore Throat

ROS:

Associated symptoms: fever, redness or eye discomfort, sneezing, wheezing, cough, runny nose, postnasal drip, GERD like symptoms, fatigue, muscle ache, n/v, and diarrhea.

Risk Factors:

Smoking, new sexual partners, irritant exposure, medications, and chronic health problems.

Red flags:

drooling, unable to swallow, unable to lie down, restless, unable to stay still, and unable to talk.

PE findings:

Epiglottis- severe illness with signs of upper airway obstruction such as restlessness, stridor, difficulty breathing, drooling, inability to swallow and high fever signals epiglottis and requires immediate referral. Further examination with a tongue blade could trigger laryngospasms and lead to airway obstruction.

Peritonsillar retropharyngeal abscess- orthopnea, dyspnea, symmetrical swelling, abscess, trismus.

Viral pharyngitis: Erythema, edema of throat, tender posterior cervical nodes.

GAS: temp more than 101.5, exudate anterior cervical lymphadenopathy.

Mononucleosis: presence or absence of pharyngeal exudate, posterior cervical lymphadenopathy, splenomegaly.

Gonococcal pharyngitis: pharyngeal exudate bilateral cervical lymphadenopathy

Inflammation: sinus tenderness, pale or swollen pharynx, postnasal drainage visible, no fever or lymphadenopathy.

Aphthous Stomatitis: shallow ulcers, no vesicles; indurated papules that progress to 1 cm ulcers; ulcer has yellow membrane and red halo; no fever or nodes.

Herpes simplex Lesions: perioral lesions; lymph adenitis; vesicles on palate, pharynx gingiva.

Herpetic pharyngitis: vesicles, ulcers, or exudate of the oral and pharyngeal mucosa.

Candidiasis: curd like white plaques that bleed when scraped off.

Differential diagnosis:

Viral Pharyngitis, Streptococcal Pharyngitis, peritonsillar or retropharyngeal abscess, Mononucleosis, Epiglottis, gonococcal pharyngitis, Herpangina, Vincent angina, Aphthous stomatitis, HSV type 1, Candidiasis, GERD.

Answer 1

Review of system

Associated symptoms: pale skin, light headedness, falling for no reason, tunnel vision, cold ar clammy skin feeling warm, blurred vision, feeling dizzy and drowsy, headache, feeling unsteady or weak when standing

Risk factors:

Dehydration, heavy sweating, overheating, exhaustion, cardiac conditions like bradycardia, tachycardia, blood flow obstruction

Red flags:

Chest pain, dyspnea, exertional onset, low back pain, palpitations, severe headache, diplopia, severe neurological deficits, ataxia or disarthria

PE findings

Seizures: myoclonic jerks, oral automation, head turning, urinary incontinence

Myocardial infarction: chest pain, neck pain, shoulder pain, dyspnea, epigastric pain, hypotension, alteration in mental status

Pulmonary embolism: chest pain, hemoptysis, rake, dyspnea

Hypotension: fainting, blurred vision, dizziness and light headedness, nausea fatigue

Dehydration: confusion, fainting,dizziness, fatigue, shock

Stroke: trouble in walking, speaking and understanding, blurred vision, light headedness, fatigue

Differential diagnosis:

Seizures, hypotension, acute aortic dissection, myocardial ischaemia, myocardial infarction, blood clot, pulmonary embolism, dehydration, postural hypotension, stroke