UST Neurological And Male Genitourinary Disorders Case Study
ANSWER
I would approach Case #2 as a clinician reviewing a 64-year-old African American woman with a bad headache and difficulties speaking.
Other subjective information
Characteristics of the headache: I would ask more questions regarding the headache, such as where it is, what kind of headache it is (throbbing, sharp, dull), how intense it is, how long it lasts, and whether it has any causes or remedies.
Ask if any accompanying symptoms, such as sensory alterations, phonophobia, phonation issues, limb weakness, or visual problems (such as aura, blind spots).
PMH: Past Medical History Look into any past migraine or headache history, stroke or transient ischemic attack (TIA) history, and other pertinent medical issues.
Ask about any recent pharmaceutical regimen changes, including over-the-counter drugs or dietary supplements.
Examine the possibility of a family history of migraines or other neurological disorders.
Other Objectivity Findings
Conduct a complete neurological examination to evaluate the patient’s cranial nerves, motor and sensory abilities, coordination, and reflexes. Observe your brain for any localized impairments.
Cranial imaging: To rule out any structural abnormalities, such as a subarachnoid hemorrhage, brain tumor, or ischemic stroke, conduct a brain MRI or CT scan.
Cardiac Evaluation: Perform an ECG to examine any potential cardiac reasons for the headache and further evaluate the irregular heartbeat.
Detection Tests:
Given the excruciating headache and trouble speaking, a brain MRI or CT scan would be necessary to check for any intracranial anomalies.
Electrocardiogram (ECG): An ECG would assist in determining any probable cardiac arrhythmias and examine the abnormal heart rate.
Perform a complete blood count (CBC) to check for any infections or unusual blood counts that might be causing the symptoms.
Alternative Diagnoses
A migraine with aura can be the cause of the patient’s past experiences with severe headaches, visual problems, and speech difficulties. The aura of a migraine can cause visual problems and speaking difficulties. Migraines frequently have a pulsatile aspect.
Transient Ischemic Attack (TIA): A TIA should be considered given the symptoms’ quick onset and speech problems. Transient Ischemic Attacks (TIAs) are brief periods of neurological impairment brought on by a momentary decrease in blood supply to the brain.
Cardioembolic Stroke: People with atrial fibrillation have a higher chance of developing blood clots in their hearts, which could result in a stroke. Speech issues and a headache could be symptoms of a stroke.
Rationales:
Migraine with Aura: The patient’s past migraine history, recurrent headaches, and visual disturbances fit the profile of migraine with aura.
Transient Ischemic Attack (TIA): A TIA, a precursor to an elevated risk of stroke, is characterized by the abrupt onset of localized neurological impairments, such as trouble speaking.
Cardioembolic Stroke: Because the patient has atrial fibrillation, she is more likely to develop blood clots, which could eventually result in a stroke and cause the symptoms that have been noted.
Teachings:
Medication Education: Go through how important it is to take medications as directed, especially those for atrial fibrillation and high blood pressure, to reduce the risk of cardiovascular events.
Lifestyle Modifications: To lower the risk of stroke and cardiovascular problems, talk about making lifestyle adjustments such as eating a heart-healthy diet, exercising frequently, and managing stress.
Stroke Awareness: Inform the patient and her family of the symptoms and signs of a stroke, emphasizing the need for prompt medical intervention if they materialize.
Remember that these suggestions are based on case-specific data, and an accurate clinical evaluation may necessitate additional assessments and factors.
QUESTION
Description
For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number. CASE #2
Case 1Case 2Case 3Chief Complaint
(CC) “It burns when I urinate”“I had a severe headache yesterday with difficulty to speak” “I have been having frequents headaches lately”History of Present Illness (HPI)A 68-year-old Caucasian male who reports to have increase on the frequency of urination with urgency for the last 5 days. He also present dysuria and nocturia.A 64-year-old African American female who reports having a severe pulsatile diffuse headache yesterday with sudden difficulty to talk with last for about two hours. She did not seek medical attention. This morning she woke up with no problems but is here today due her husband advise. A 25-year-old Hispanic female presents to your clinic with a headache located on right temporal area, pulsatile.PMHBenning prostatic hyperplasia diagnosed 3 years ago, UTI 6 months ago, Lithotripsy left kidney 10 years ago. No issues after treatmentAtrial Fibrillation, Hypertension. Is allergic to Non-steroidal Anti-inflammatory drugs Aspirin Frequent headaches since I was 15, with menses. Drug HxRosuvastatin 20 mg
Olmesartan 20 mg
Losartan 50 mg
Xarelto 15 mg BID
Ibuprofen for HeadachesSubjective
Fever and chills, no changes in vision or hearing, no difficulty chewing or swallowing. No sexually active, nocturia, dysuria.
Yellowish urethral secretion. Feels Palpitations, joint pain with yesterday’s episodeLight makes headache worst Nausea associated with headaches. No vomiting, Headaches improve usually with rest, ibuprofen, and sleep, but it is annoying to have to sleep all-dayObjective Data VSB/P 150/96; Pulse 89; RR 16; Temp 99.4; Ht 6,1; wt 180; B/P 131/80; temperature 98.2°F; (RR) 18; (HR) 84, irregular; oxygen saturation (PO2) 96%; B/P 108/64; Pulse 86; RR 16; Temp 98.6;
Generalwell-developed male, no acute distresswell-developed female, no acute distress25-year-old female appears well developed and well-nourished, healthy appearing, wearing dark glasses in a dim room HEENTAtraumatic, normocephalic, PERRLA, EOMI, arcus senilus bilaterally, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition.
no injection, anicteric, PERRLA, EOMs intact, without pain to movement; normal visionLungsCTA AP&L
CTA AP&L
CTA AP&LCardS1S2 without rub or gallop S4 presentIrregular heart beat with normal rateS1S2 without rub or gallopAbdNo tenderness normoactive bowel sounds x 4; No tenderness normoactive bowel sounds x 4;
benign, normoactive bowel sounds x 4;
Rectal examWarm, swollen and painful prostate glandNon contributoryNon contributoryIntegumentgood skin turgor noted, moist mucous membranesintact without lesions masses or rashes.intact without lesions masses or rashes.NeuroNo obvious deformities, CN grossly intact II-XIINo obvious deficits and CN grossly intact II-XIICranial nerves II to XII intact; sensation intact, DTRs 2+ throughout.
Functional neurological exam is WNL
Once you received your case number, answer the following questions:
What other subjective data would you obtain?
What other objective findings would you look for?
What diagnostic exams do you want to order?
Name 3 differential diagnoses based on this patient presenting symptoms?
Give rationales for your each differential diagnosis.
What teachings will you provide?
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