|
|
December Case 1
|
Logged in as: Guest
|
|
Users viewing this topic:
none
|
|
Login  | |
|
December Case 1 - December 6, 2007 11:41:08 AM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
25 year old male presents from his Primary Care Physician office with a diagnosis of "polyarthralgia" and fatigue. He says "my family doc didn't really even examine me".
He notes for the past month he has had worsening joint pain and decreasing appetite. "Man, a whole bunch of stuff has been going wrong, I feel like I am 80".
He has an envelope of tests that he has brought with him
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
RE: December Case 1 - December 6, 2007 12:04:21 PM
|
|
|
buckeye
Posts: 175
Joined: May 24, 2007
Status: offline
|
Could be a wide range of issues - systemic disease, metabolic, or infection come to mind. What are the various test results in the envelope. What is his appearance? Vital signs?
|
|
|
|
|
RE: December Case 1 - December 6, 2007 12:06:17 PM
|
|
|
buckeye
Posts: 175
Joined: May 24, 2007
Status: offline
|
Any skin lesions suggestive of insect bites? Any exposure to chemicals?
|
|
|
|
|
RE: December Case 1 - December 6, 2007 12:24:45 PM
|
|
|
ehanso
Posts: 355
Joined: September 14, 2004
From: Minnesota
Status: offline
|
Lymes' Disease
|
|
|
|
|
RE: December Case 1 - December 6, 2007 1:45:25 PM
|
|
|
Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
What does he do for a living/hobbies? Is he married or single, has he traveled out of the country recently? What are his vitals and labs showing? Any history of depression or mental illness or SAD? What is the "bunch of stuff" that has been going wrong? How does he describe his fatigue? What makes this unusual compared to his prior status?
|
|
|
|
|
RE: December Case 1 - December 6, 2007 9:34:47 PM
|
|
|
jma
Posts: 2414
Joined: August 24, 2000
From: NY
Status: offline
|
Does he have a mark on the body, indicative of a rash? What from the mutlitude of tests that were done, caught your eye?
|
|
|
|
|
RE: December Case 1 - December 7, 2007 1:21:12 AM
|
|
|
bonez
Posts: 232
Joined: August 29, 2007
Status: offline
|
Well he is in the right age range for several things. Many arthritides have accompanying anemia which might explain the joint pain and fatigue. The onset is abrupt and might not support those conditions. Is there more info labs physical exam weight loss familial Hx. Recent travel out of the US to say tropical countries?
Let's have it Doc.
|
|
|
|
|
RE: December Case 1 - December 7, 2007 8:29:45 AM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
"I just have been having sooo many problems!" "For the past 2 weeks I can barely go up and down steps, last month my ankles were killing me and the month before that it was my elbows!...I feel like I am 80"
"Then I got this weird 'strep throat thing', except my throat didn't feel all that bad, it was really my mouth"...that happened about 2 monts ago, it still comes and goes" "Just so much bad luck I can't even tell you!"
Vitals
HR 80, resp 14, temp 98.9, o2 100%
CBC:
wbc 9
hgb 14
hct 35
plt 220
BMP
na 140
k 4
cl 108
co2 28
cr 1
bun 18
gluc 102
ESR 50
knee xray "no acute disease or pathological process"
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
RE: December Case 1 - December 7, 2007 9:28:10 AM
|
|
|
buckeye
Posts: 175
Joined: May 24, 2007
Status: offline
|
Any thyroid tests?
|
|
|
|
|
RE: December Case 1 - December 7, 2007 12:08:41 PM
|
|
|
ehanso
Posts: 355
Joined: September 14, 2004
From: Minnesota
Status: offline
|
What test is done for mononucleosis?
|
|
|
|
|
RE: December Case 1 - December 7, 2007 2:54:34 PM
|
|
|
Shill
Posts: 1097
Joined: February 13, 2003
From: Madison WI USA
Status: offline
|
So Sed rate is way up, and Crit is somewhat low. Are these the only abnormal results? I have no idea what this means, but I will guess acquired hemolytic anemia.
|
|
|
|
|
RE: December Case 1 - December 7, 2007 3:48:14 PM
|
|
|
steve
Posts: 470
Joined: May 14, 2003
From: Canada
Status: offline
|
ESR being so elevated doesnt mean much on its own but in light of his history I would be suspicious of sinister pathology like lymphoma or rheumatic conditions.
|
|
|
|
|
RE: December Case 1 - December 7, 2007 5:31:23 PM
|
|
|
Dr.Wagner
Posts: 1242
Joined: January 24, 2003
From: Indianapolis
Status: offline
|
Mono test negative
_____________________________
Dr. Wagner DO
Moderator of Medical Complexity Forum
|
|
|
|
|
RE: December Case 1 - December 7, 2007 5:47:29 PM
|
|
|
wooooo
Posts: 3
Joined: December 7, 2007
Status: offline
|
any RA profile
|
|
|
|
|
RE: December Case 1 - December 7, 2007 6:09:54 PM
|
|
|
jimptdpt
Posts: 29
Joined: December 1, 2003
From: Medway, Ma, usa
Status: offline
|
Since he's 25 y/o and the throat thing made me think. I was thinking some type of STD, Herpes or Gonorrhea.
|
|
|
|
|
RE: December Case 1 - December 7, 2007 10:24:21 PM
|
|
|
wooooo
Posts: 3
Joined: December 7, 2007
Status: offline
|
Reiter's syndrome
|
|
|
|
|
RE: December Case 1 - December 8, 2007 12:08:24 PM
|
|
|
bonez
Posts: 232
Joined: August 29, 2007
Status: offline
|
Well the high ESR and eye issues point to Behcet's syndrome. With his vascular lesions he will need treatment. Maybe thalidomide will resurface to save the day?
|
|
|
|
|
RE: December Case 1 - December 8, 2007 12:17:14 PM
|
|
|
wooooo
Posts: 3
Joined: December 7, 2007
Status: offline
|
With the vascular lesions, I have to go with Behcet's syndrome also.
|
|
|
|
 New Messages |
 No New Messages |
 Hot Topic w/ New Messages |
 Hot Topic w/o New Messages |
 Locked w/ New Messages |
 Locked w/o New Messages |
|
 Post New Thread
Reply to Message
Post New Poll
Submit Vote
Delete My Own Post
Delete My Own Thread
Rate Posts |
|
0.188
|
Printable Version
