John is 14 years old white male. He’s taken to the doctor’s office by his mother.

Mystery Disease

Context

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John is 14 years old white male. He’s taken to the doctor’s office by his mother. He tried to play baseball at 10 years old but his coordination was not good, he gets tired very quickly, and his leg muscle aches. . He has been growing very fast over the last year or so, and he was wearing size 12 shoe, but without putting on muscle weight like his brother did at that age. Furthermore, his knee joints have been swelling and he has a perpetual sore on his right calf that won’t heal. He has also been complaining that he doesn’t feel good.

Patient responses and pertinent information (DO NOT ADD YOUR OWN)

How you are feeling. I have been feeling really tired and rundown. It has been hard to concentrate on my homework or have the energy to do anything. I feel like, numb, about stuff.

How long have your knees been hurting? 2-3 months on and off

What have you been doing for the pain and swelling? Mom gives me ibuprofen

ASSESSMENT:

VS: BP 130/82, PULSE 76, RR 16, T 98.4F, WEIGHT 145 lb, HEIGHT 5’11”

General: 14 y.o. tall, thin, Caucasian male, alert and oriented x3 (A&O x3), low level distress.

HEENT (head, eyes, ears, nose, throat): Normocephalic without evidence of trauma, PEERL (Pupils equal and reactive to light), mucous membranes pink and moist.

Neck supple w/out lymphadenopathy (swollen lymph nodes), thyromegaly (goiter or enlarged thyroid) or carotid bruits (noisy carotid pulse).

LUNGS: Clear to auscultation bilaterally throughout (CTA)

Heart murmur identified.

Questions

Please take your time answering these 6 questions below by proving as much details as possible!!!!!!!!!

Knowing this information, what 5 other specific questions would you ask? (5 points)

Remember to frame the questions correctly. For example – if it is a minor, many of the questions should be addressed to the parents.

A) Section 2 Labs (2 parts): Part 1 – (10 pts) This explains how you will continue your work-up with other commonly applied tests. You need to describe specifically what the tests will analyze and if there is anything in particular in that test that pertains to the situation.

Here YOU will provide the tests to be done that are routine, describe what they test for and include their normal range. You can use the example as a template. However, do not make up results. Just tell me what you will do, why and how.

Key Lab Results:

Testosterone: 4 ng/dL

Thyroid Hormone (free T3): 1 pg/mL

Growth Hormone: 26 ng/mL

       2.   B) – List your findings so far (10 points): (This is not because I want you to regurgitate what is already written. This is an important exercise because it forces you to go over in DETAIL all information in the case. Therefore, this section needs to be detailed because it is the subtleties between symptoms and the patient history that give you the important clues to correctly diagnose the patient. Also you want to correctly report these to the doctor so she/he has all the information in formulating an appropriate approach to treatment).

Diagnoses: Short list of possible ailments. 15 points.

What is your short list of 3 diagnoses with a rationale why you chose those. The rationale should show a direct relationship to the findings and ROS: (This should be the 3 best possibilities. You need to be in the ballpark. In other words, if it is a fungal infection in the lungs and you put viral or bacterial, then you will points off BECAUSE there will be important information that leads you to that possibility. If you state cancer as a possibility or maybe COPD, then you will NOT get points off even if you do not put the actual case diagnosis.)

Plan: Follow up tests/studies – 15 points

This section is important because you will chose THE MOST LIKELY DIAGNOSIS IN YOUR OPINION and follow up with that one diagnosis only. These tests should be specific in nature and allow you to determine whether or not the patient has that particular problem/disease. You should include information demonstrating you understand how the test is conducted, any principles behind it and predict what it will show. These tests can either be specific for the condition (if commercially available) or exclusive of other conditions (ruling the other stuff out).

Pathophysiology: 25 points. Even if your diagnosis is not the actual one, as long as you have a good explanation for the ONE you chose, you WILL GET FULL CREDIT. There are 4 criteria you should always address in this answer. 1) How does the disease/condition make the person feel sick, 2) what is a treatment for it, 3) how does the treatment work to counter the disease/condition, 4) how does it affect the patient’s symptoms. Remember this section alone is worth 25% of this part of the exam. So be as thorough as possible.

– Follow-up – 5 points

In this section, you describe different things you would look for and ask about in a follow up appointment with the patient. You will be responsible for determining how the patient is responding.