Differential Diagnosis Exercises

You want to create a Differential Diagnostic list for each of the cases presented here. You want to rank the list from the most to least likely. Secondly, provide next to each of the possible diagnoses concerns from the history, PE and or test results provided that support the diagnosis, as this information will help you rank the list. Since, you have not had the pathophysiology content as yet to identify fully with the list of possible diseases you do not need to place testing and or treatments you would consider next to each.

You will notice that the cases have become more complex with an increasing amount of information provided for each. This is deliberate, first focusing on the sign/symptom providing a differential list with the information that you have and then building on more complex information that will help you to rank and state why a diagnosis would not be considered in a particular case. The focus sign/symptom is provided for you at the end of each case.

 

Case #1

14 day old former 28 week gestation male infant, now 30 weeks adjusted age.

Resp: CPAP 7, 21% oxygen. stable with few A/B’s self resolving, on caffeine

CV: Hypertension, BP 101/66 LA, 102/72 RA, 110/64 LL, 112/63 RA noted today; umbilical venous catheter (UVC) placed on admission, discontinued DOL 6.
FEN: voiding and stooling WNL. Feeding 24 cal/oz maternal breast milk (using human milk fortifier) @ 160ml/kg/d per gavage
Heme: Blood type A (+); Hct. 36%; plt. 189K
ID: initial R/o sepsis, abx x 48hrs upon admission. Blood cx. (-) final
Neuro: HUS DOL 10 Gr. I IVH on the right
HEENT: anterior fontanel open soft & flat; eyes normal position, (+) red reflex; nares patent bilaterally, RAM cannula in placed nasal septum intact; ears of normal rotation, without preauricular pits or sinus; mouth palate intact; neck: supple without masses.
Resp.: breath sounds are clear and equal bilaterally

CV: heart S1 & S2 audible without murmur, peripheral pulses are of normal intensity and present in all 4 extremities, color pink, capillary refill of <3 seconds upper and lower extremities
GI: abdomen soft & flat, without organomegaly, anus is patent; G.U.: non-dysmorphic male, testes high in the canal; Extremities: 10 digits hands and feet, Hips (-) Ortolani and Barlow’s maneuver bilaterally.
Neuro: Tone AGA; spine intact without pits or sinus; Skin Pink, well perfused.

DD for Hypertension

use apa format when referencing info. thank you!

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