Hi,

I would like someone to review the case study from attachment very careful (please review several times). From the case study above, please compare the diagnosis with I have below and assist me with any new diagnosis with the table in section 2. Please create from most to least important diagnosis.

PLEASE COMPLETE BY 5 PM TODAY.

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1. HOMEWORK INSTRUCTIONS

“Differential Diagnosis Table

a. Complete a differential diagnosis table for this patient (see below)

i. A differential diagnosis list is a list of all the possible diagnoses this patient could have based on the symptoms the patient presents with, the available history and the physical exam. Examine what you know about this patient, and consider the pathophysiology as you make your list of possible diagnoses.

ii. You should be able to generate a list of at least 4-5 possibilities, though there is space for more if you would like.

iii. Put them in a list of most likely being number 1, to less likely.

1. Your number one diagnosis is the one you think this patient has, given the history and physical exam. This is the most likely diagnosis given that there are more clinical manifestations and findings in the history and exam that support this diagnosis.

2. Include any differential that you think is appropriate for this patient, given the information you have, but make sure it is in the order of most likely.

3. Be specific in your possible diagnosis. Do not use generic diseases or diagnoses. If there are more than one type of a disease, list each separately, as likely the pathophysiology is different.

THIS IS MY OWN DIAGNOSIS

 

Possible Diagnosis (listed in order   of likelihood)

Signs and Symptoms seen in This patient   that make you consider this as a diagnosis

 

1.Spinal tumors

-Fever, weakness in his feet and ankles, and inability to walk. Unable   to walk secondary to weakness, weight loss, history of smoking for 20   years, obesity (32% of BMI), back pain and wake up at night, throbbing, achy   low back pain, buttock and legs, numbness, tingling and burning sensation in   feet, toes, and fingertips, bladder problem with one time incontinence, positive   with neuro exam.

 

2.Type 2 Diabetes

Numbness, tingling, and burning sensation in feet, toes, and fingertips, fatigue,   high fat and calories intake, sedentary lifestyle.

 

3.Peripheral artery disease

Smoking, over 50, leg numbness or weakness, painful with activities

 

4.Pernicious anemia and iron deficiency anemia

Moderated alcohol and low iron diets (not eating redmeat).

 

5. Stomach flu

N&V and fever

 

6.

 

7.

 

8.

2. PLEASE COMPARE WITH THE DIAGNOSIS ABOVE AND NEW DIAGNOSIS THAT YOU HELP ME TO CREATE IN THE TABLE BELOW WITH CLEAR SIGNS/SYMPTOMS OF THE PATIENT AND RELATED TO THE PATHOPHYSIOLOGY (As many as diagnosis on the table below).

 

Possible Diagnosis (listed in   order of likelihood)

Signs and Symptoms seen in This patient   that make you consider this as a diagnosis

 

1

 

2

 

3

 

4

 

5

 

6

 

7

 

8

 

9

 

10

1

Nursing 523 Midterm

History of present condition: George is a 50 yo business executive who presents with complaints of weakness in his feet and ankles, and inability to walk. His toes and feet are numb and tingly. He feels like his is unable to walk secondary to weakness in his legs. His low back is painful, and he had an episode of urinary incontinence this morning. His fingertips are also tingly. He’s brought by his wife, and with his 2 nephew’s to help him walk. He feels like he is getting much worse. Past medical and surgical history

� Intermittent back pain. He states he has a long standing problem with his back with occasional exacerbations after a weekend of working in the yard. Sometimes he will engage in physical activity, like playing softball or basketball on the weekends, which will cause him to have problems for several days. 5 days ago, he was cutting and stacking firewood, but didn’t finish because he didn’t feel very well. Doesn’t remember hurting back but was doing some twisting and lifting, which has caused him back pain before.

� No surgeries Allergies

� Medicinal allergies: Denies � Environmental allergens: Denies � Food allergens: NKDA

 

 

2

Medications: Ibuprofen prn. Lifestyle General: Works for a telecommunications industry as an executive. Some travel, most recently 2 months ago to Chicago. Married, no kids. Physical activity: Fairly sedentary. Limited exercise except on weekends. Sleep: Has not been sleeping well in last week secondary to GI distress (resolving) and back pain. High risk behaviors: ETOH moderately on weekends, none in last week secondary to vomiting and diarrhea episode. Smokes 1ppd x 20 years. No recreational drugs. Diet Usually normal diet, somewhat high in fat and calories. Trying to “do better” with chicken and fish instead of red meat, but had recent vomiting and diarrhea after eating chicken, and hasn’t been interested in chicken since. Relevant review of systems

ROS: General malaise, some wt loss over last week. Cardiovascular: Denies chest pain Respiratory: Denies cough, shortness of breath. Gastrointestinal: Denies present nausea, vomiting or diarrhea. Had 3-4 day course of v/d (nonbloody) last week after eating chicken. Resolved. Drinking fluids. Not much appetite. Genitourinary: No dysuria. Incontinence of urine this am. Musculoskeletal: Feels weak, mostly in legs. Throbbing, achy low back pain, buttock and legs. Integumentary: Denies rashes or bruising. Neurological: Denies headache, neck pain. Numbness, tingling and burning sensation in feet, toes and fingertips.

Physical exam BP: 105/66 RR:16 temp:100.8 pulse:62 ht:70 in wt:220 lbs RA Sat 97%

� General: awake and alert, oriented x 4. Appears tired, but nervous, sitting in wheelchair.

� HEENT: normocephalic, atraumatic. Pupils =, reactive to light and accommodation. Ears clear, oropharynx without signs of redness, lesions. Airway patent. Speech clear. Neck supple. Full range of motion.

 

 

3

� Lungs: clear to auscultation bilaterally. Easy unlabored on room air. � CV: S1S2, no rubs, no murmurs. � Abdomen: mild abdominal obesity, otherwise normal. Soft, nontender. � Extremities: warm, well perfused. No edema. � Back: No midline pain to thoracic or lumbar spinous processes. Atraumatic.

Tender to palpation to bilat lower lumbar paraspinal region. � Skin: no rashes or lesions � Neuro: Cranial nerves II-XII grossly intact. Motor: 2+/5 bilat toe flexion and

extension, ankle flexion and extension symmetrically. Quads 3+/5 bilat and symmetric. All other muscle testing 5/5. Reflexes: Unable to obtain bilat ankles, 1+ bilat knees, biceps, brachioradialis 2+ triceps. Sensory: Dysesthesias in bilat legs below knees, sacral area and all fingers on exam to light touch. Unable to stand for exam secondary to weakness.

Hi,

I would like someone to review the case study from attachment very careful (please review several times). From the case study above, please compare the diagnosis with I have below and assist me with any new diagnosis with the table in section 2. Please create from most to least important diagnosis.

1. HOMEWORK INSTRUCTIONS

“Differential Diagnosis Table

a. Complete a differential diagnosis table for this patient (see below)

i. A differential diagnosis list is a list of all the possible diagnoses this patient could have based on the symptoms the patient presents with, the available history and the physical exam. Examine what you know about this patient, and consider the pathophysiology as you make your list of possible diagnoses.

ii. You should be able to generate a list of at least 4-5 possibilities, though there is space for more if you would like.

iii. Put them in a list of most likely being number 1, to less likely.

1. Your number one diagnosis is the one you think this patient has, given the history and physical exam. This is the most likely diagnosis given that there are more clinical manifestations and findings in the history and exam that support this diagnosis.

2. Include any differential that you think is appropriate for this patient, given the information you have, but make sure it is in the order of most likely.

3. Be specific in your possible diagnosis. Do not use generic diseases or diagnoses. If there are more than one type of a disease, list each separately, as likely the pathophysiology is different.

THIS IS MY OWN DIAGNOSIS

Possible Diagnosis (listed in order of likelihood) Signs and Symptoms seen in This patient that make you consider this as a diagnosis
1.Spinal tumors -Fever, weakness in his feet and ankles, and inability to walk. Unable to walk secondary to weakness, weight loss, history of smoking for 20 years, obesity (32% of BMI), back pain and wake up at night, throbbing, achy low back pain, buttock and legs, numbness, tingling and burning sensation in feet, toes, and fingertips, bladder problem with one time incontinence, positive with neuro exam.
2.Type 2 Diabetes Numbness, tingling, and burning sensation in feet, toes, and fingertips, fatigue, high fat and calories intake, sedentary lifestyle.
3.Peripheral artery disease Smoking, over 50, leg numbness or weakness, painful with activities
4.Pernicious anemia and iron deficiency anemia Moderated alcohol and low iron diets (not eating redmeat).
5. Stomach flu N&V and fever
6.  
7.  
8.  

 

 

2. PLEASE COMPARE WITH THE DIAGNOSIS ABOVE AND NEW DIAGNOSIS THAT YOU HELP ME TO CREATE IN THE TABLE BELOW WITH CLEAR SIGNS/SYMPTOMS OF THE PATIENT AND RELATED TO THE PATHOPHYSIOLOGY (As many as diagnosis on the table below).

Possible Diagnosis (listed in order of likelihood) Signs and Symptoms seen in This patient that make you consider this as a diagnosis
1  
2  
3  
4  
5  
6  
7  
8  
9  
10  
 
 
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