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 1Case 2Case 3Chief Complaint
(CC) A 57-year-old man presents to the office with a complaint of left ear drainage since this morning.A 45-year-old female presents with a complaint of an itchy red rash on her arms and legs for about two weeks.A 11-year-old female patient complains of red left eye and edematous eyelids. Her mother states the child complains of “sand in my left eye.”SubjectivePatient stated he was having pulsating pain on left ear for about 3 days. After the ear drainage the pain has gotten a little better.She has been going on a daily basis to the local YMCA with children for Summer camp.Patient noticed redness three days ago. Denies having any allergies. Symptoms have gotten worse since she noticed having the problem.Objective Data VS(T) 99.8°F; (RR) 14; (HR) 72; (BP) 138/90(T) 98.3°F; (RR) 18; (HR) 70, regular; (BP) 118/74(T) 98.2°F; (RR) 18; (HR) 78; BP 128/82; SpO2 96% room air; weight 110 lb. Generalwell-developed, healthy malehealthy-appearing female in no acute distresswell-developed, healthy, 11 years old HEENTEAR: (R) external ear normal, canal without erythema or exudate, little bit of cerumen noted, TM- pearly grey, intact with light reflex and bony landmarks present; (L) external ear normal, canal with white exudate and crusting, no visualization of tympanic membrane or bony landmarks, no light reflex EYE: bilateral anicteric conjunctiva, (PERRLA), EOM intact. NOSE: nares are patent with no tissue edema. THROAT: no lesions noted, oropharynx moderately erythematous with no postnasal drip.
EYES: no injection, no increase in lacrimation or purulent drainage;
EARS: normal
TM: Normal
EYES: very red sclera with dried, crusty exudates; unable to open eyes in the morning with the left being worse than the right SkinNo rashesCTA AP&LCTA AP&LNeck/Throatno neck swelling or tenderness with palpation; neck is supple; no JVD; thyroid is not enlarged;
trachea midline
mild edema with inflammation located on forearms, upper arms, and chest wall, thighs and knees; primary lesions are a macular papular rash with secondary linear excoriations on forearms and legs
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.
Submission Instructions:
Your instructor will assign you your case number and you will post on the case number you have been assigned.
You will reply to the other two case studies (One of each).
Your initial post should be at least 500 words, formatted and cited in current APA style with support from at least 2 academic sources. Your initial post is worth 8 points.
You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
All replies must be constructive and use literature where possible.
Please post your initial response by 11:59 PM ET Thursday, and comment on the posts of two classmates by 11:59 PM ET Sunday.
You can expect feedback from the instructor within 48 to 72 hours from the Sunday due date.
Expert Solution Preview
In this case, the patient is a 57-year-old man presenting with left ear drainage since this morning. Based on the limited information provided, here are the responses to the given questions:
1. What other subjective data would you obtain?
In order to gather more subjective data, it would be important to ask the patient about the characteristics of the ear drainage, such as color, consistency, and odor. This will help in identifying whether it is clear, bloody, purulent, or foul-smelling. Additionally, asking about the presence of any associated symptoms such as pain, hearing loss, dizziness, or history of ear infections would provide further information.
2. What other objective findings would you look for?
Apart from the subjective presentation, objective findings should also be assessed. In this case, it would be important to thoroughly examine the patient’s ear. This will involve inspecting the external ear for erythema, swelling, or signs of infection. The ear canal should be examined for any discharge, cerumen buildup, or obstruction. Visualization of the tympanic membrane is essential to check for perforation, erythema, or effusion. Assessment of other areas such as the throat and neck, specifically looking for signs of inflammation or tenderness, would also be relevant.
3. What diagnostic exams do you want to order?
Based on the initial assessment, specific diagnostic exams may be warranted. To confirm or rule out an underlying ear infection, a swab or culture of the ear drainage may be necessary. In addition, a complete blood count (CBC) could provide insights into the presence of infection or inflammation. A hearing test (audiometry) may also be considered to assess any potential hearing loss.
4. Name 3 differential diagnoses based on this patient’s presenting symptoms.
a) Otitis media: Inflammation or infection of the middle ear, potentially caused by viral or bacterial pathogens.
b) Otitis externa: Infection or inflammation of the external ear canal, often associated with excessive moisture or swimming.
c) Traumatic perforation of the tympanic membrane: Injury or rupture to the eardrum resulting from trauma or pressure changes, leading to ear drainage.
5. Give rationales for each differential diagnosis.
a) Otitis media is a common condition characterized by ear pain, fever, and occasionally ear drainage. The presence of ear drainage in this case supports this diagnosis.
b) Otitis externa typically presents with ear canal inflammation, pain, and discharge. The patient’s symptoms of ear drainage and the presence of erythema and crusting of the external ear canal raise suspicion for otitis externa.
c) Traumatic perforation of the tympanic membrane can occur due to various reasons, including barotrauma or direct trauma to the ear. It can result in ear drainage and requires further evaluation to confirm.
Note: It is important to remember that these are preliminary differential diagnoses based on the limited information given. A thorough medical history, physical examination, and appropriate diagnostic tests would be required for definitive diagnosis and treatment planning.
