differential diagnosis
- Thread starter Rÿcher
- Start date
patient had a good night out on the piss.
Patient is attending a Celine Dion concert.
TheLonelySquire
Vice Admiral
Patient is Hillary Clinton stumping for Barack Obama.
Patient did some bad shrooms or acid.
Rÿcher
Fleet Captain
Patient does not like Celine Dion.
Patient saw the Get Smart movie and felt really good after having seen miss Anne Hathaway.
Patient does not have a history of asthma or other breathing problems. Tox-screen showed no evidence of psilocybin or lysergic acid compounds.
Lupus.
I hope this is just an exercise and not a real attempt to diagnose something. If you have a real patient with real concerns, you should definately be checking with a qualified professional who is in position to actually assess the person and NOT just making stabs in the dark on a BBS. Anyhow, here goes.
First, not much to go on here without a proper history. Is the patient lucid? If so, is there a history of migraine (migraine being a very specific type of headache and not just a really BAD headache)? Also pts with migraines often find it very difficult to sleep, so "migraine" again becomes a curious symptom. Are we sure we don't mean "really bad headache"? Does the pt have photobobia, see auras? Have a history of classic or common migraines? If previously diagnosed with migraines, that alone could accomodate all the symptoms (even though sleeplessness is far more common than hypersomnia).
I would first assess whether the Pt was lucid and responsive. If so, then ascertain a solid history. Is there any pattern of substance abuse/use or any change in taking medicines (new prescriptions or new OTC remedies)? Were these symptom sudden onset, simultaneously or did they appear insideously? IMPORTANT--PERLA!! Are the pt's pupils equal and responsive to light? It IS possible such symptoms could indicate a subdural hematoma, bulging aneurysm, tumor or other SOL (space occupying lesion). Check pt's eyes with opthalmoscope to see if there is flattening of the optic disk or any other indications of increased interocular pressure. Baseline on blood pressure would be a good figure to have also--especially if we are considering an aneurysm.
Does pt have neck pain or stiffness, particularly on forward flexion? This, accompanied with fever may indicate a meningitis. If fact, is there ANY recent history of illness or exposure so an ill person? Is the "hypersomnia" actually that or does the pt have trouble remaining conscious? A few cognition tests would be useful here.
Is there a history of trauma? Falls or accidents? Blows to the head? Not just in the last day or so but in the last couple weeks. A subdural hematoma can bleed slowly for a long time before it starts showing problems.
Without a history or any exams, these symptoms could include anything from chemcial intoxication to a flu or food allergy, to more serious concerns like meningitis, subdural hematoma, aneurysm, or even brain tumor. Something as simple as pts temperature could be enlightening and tell us if we might be looking at an infections of some sort. A doctor's responsibility is to consider the most threatening consideration first and work backward. An acute onset of nausea and vomiting is unlikely to be caused by a tumor becasue it's a slow process so it seems a safe differential to eliminate (for the moment) and also, it's not a fast acting agent so you can back burner it as a concern even though it might have the most dire implications if it were to be the case.
A LOT of possibilities and very little to go on based on symptoms alone.
Again though, if this is about a real person and you have genuine concern--CHECK with a local physician. Asking strangers on a BBS is no way to really administer health care.
patient must have been very naughty this year, suggest being nice next year.
Rÿcher
Fleet Captain
ok, ok...
This was a few years ago. I had bought a leather jacket and I had sprayed it down with that protectant stuff they sell you at the store without adequate ventilation. That night and into the next day, I had vomiting, night sweats, terrible dreams, i tried taking medicine for the headaches but I couldn't keep anything down. I was throwing up bile. It was a disaster. That night I called out of work an hour before I was supposed to be there from the emergency room. They couldn't figure out what was wrong with me. They hooked me up to an IV and eventually they gave me something for the nausea and an intra-muscular injection of Imitrex for the migraine (hurt like a motherfucker) and sent me on my way. I felt right as rain the next morning.
I haven't slept for 36 hours before.
I just want to know what was wrong with me.
This was a few years ago. I had bought a leather jacket and I had sprayed it down with that protectant stuff they sell you at the store without adequate ventilation. That night and into the next day, I had vomiting, night sweats, terrible dreams, i tried taking medicine for the headaches but I couldn't keep anything down. I was throwing up bile. It was a disaster. That night I called out of work an hour before I was supposed to be there from the emergency room. They couldn't figure out what was wrong with me. They hooked me up to an IV and eventually they gave me something for the nausea and an intra-muscular injection of Imitrex for the migraine (hurt like a motherfucker) and sent me on my way. I felt right as rain the next morning.
I haven't slept for 36 hours before.
I just want to know what was wrong with me.
Likely chemical poisoning--OR an allergic reaction to the chemicals. Sudden onset of symptoms with a temporal relationship to use of a potentially toxic substance. Did the spray have any warning labels or describe any symptoms of toxic exposure? They often do, you know.
Also, again, migraines are VERY specific types of headaches with unique characteristics and are usually established through history. They are NOT just "very bad headaches".
Take the Dr. House strategy. Narrow it down to 4 or 5 causes, and then pump you full of drugs for one of the potention causes and wait to see what those drugs break. Based on that info, narrow it down one or two more causes. 
Take the Dr. House strategy. Narrow it down to 4 or 5 causes, and then pump you full of drugs for one of the potention causes and wait to see what those drugs break. Based on that info, narrow it down one or two more causes.
Sounds to me that they did what the medical industry so often does; kept him hydrated and treated the SYMPTOMS with pain-relievers, allowed his body time to clear ITSELF of the toxins and then congratulate themselves as miracle-workers for having "healed" him.
Patient was interrogated by Jack Bauer.
Patient saw the Get Smart movie and felt really good after having seen miss Anne Hathaway.
Yes, she has grown up nicely, hasn't she?
Why is that funny?
It's a recurring House diagnosis that is always dismissed
Why is that funny?
