Differential Diagnosis

Question 1

Gloria 54 year old female, complains of temporal headaches and ringing in the ears. These are bilateral headaches, present for last 6 months. It has been a stressful month. Name three Differential Diagnosis and justify each.

Answer 1

• temporal arteritis - severe headaches at temples, fatigue, strikes mostly older females
  *idiopathic intracranial hypertension- temporal headache, sleep disturbances
• cervicogenic headaches-
• neurofibromatosis II bilateral acoustic- headaches, hearing loss tinnitus, severe disorientation when scuba diving

Question 2

what examinations would you do for Gloria?

Answer 2

cervical examination, hearing test. Referral

Question 3

Caitlyn 29-year-old female with right-sided low back pain. constant pain that began during a morning routine jog. Initially sharp and since diminished. Aggravated by sneezing and intraabdominal stress. Menstrual cycle irregular with spotting. A feeling of bloating in the lower abdomen. Intercourse is painful. Name three Differential Diagnosis and justify each.

Answer 3

• Endometriosis- pelvic bilateral pain, associated with menstruation, dyspareunia, dysuria
• Pelvic Inflammatory Disease- Lower abdominal pain; Menstrual irregularity; spotting, dyspareunia)
• Endometrioma burst -chronic pelvic pain in belly, irregular periods, dyspareunia,

Question 4

what examinations would you do for Caitlyn?

Answer 4

abdominal palpation for tenderness.
refer for laparoscopy of the uterus; gynecological examination

Question 5

James 22-year-old male with knee pain- localized pain over the anterior aspect of the left knee below the patella. This worsens with activity, particularly walking up and down stairs and improves with rest. Gradual onset over last month. Name three Differential Diagnosis and justify each.

Answer 5

• Patellofemoral Pain Syndrome (worsens with activities, climbing stairs… slow onset.
  *Chondromalacia (softening of articular cartilage) affects one joint, convex patellar joint, exacerbated by activity,
• Patellar tendinopathy. Pain localised to inferior pole of patellar. Common in active males, worse under activity such as climbing stairs, reduced strength. Relieved by rest

Question 6

what examinations would you do for James?

Answer 6

knee examination and palpation; range of motion. Referral for radiography and or corticosteroid injection.

Question 7

4. Elizabeth, a 62-year-old woman has presented to your clinic complaining of left lateral hip pain and aching in the lateral aspect of the left thigh. Elizabeth reports the pain has been ongoing for approximately three (3) months now but she cannot recall any preceding injury, event, or trauma preceding onset. Elizabeth reports she is most aware of the pain when sitting or applying pressure over the side of the hip, such as sleeping at night if she is on her left side. Name three Differential Diagnoses and justify each.

Answer 7

• Trochantic bursitis (Greater trochantic pain syndrome) bursitis and tendinopathy. (exacerbated by lying on it, sitting)
• Gluteal tendinopathy
  Causes tendon tissue to break down- common in older post-menopause females.
• Osteoarthritis of hip
  Pain in hip joint, joint stiffness, fatigue

Question 8

what examinations would you do for Elizabeth?

Answer 8

hip range of motion… referral for hip MRI

Question 9

5. You are sitting on a train and observe a woman sitting opposite who has a large symmetrical anterior midline neck mass. Name three Differential Diagnoses and justify each.

Answer 9

Goitre – Graves Disease

Hypopharyngeal cancer- the lower part of the throat above esophagus

Question 10

What examinations would you do for this woman?

Answer 10

Thyroid palpation

Question 11

6. A 52-year-old male presents with fatigue, abdominal distension, and a general feeling of lassitude. Slightly jaundiced. bruises on hands, legs, and abdomen. The abdomen is distended and there is tenderness in the right subcostal area. Name three Differential Diagnoses and justify each.

Answer 11

• Liver cancer
  ( weak and tired, lump in right side of abdomen, swelling of abdomen -ascites- yellowing of skin)
• Pancreatic cancer: jaundice, abdominal pain and distension
• Peritonitis (belly pain and swelling; haemotoma; fatigue;
• has he been assaulted?

Question 12

What examinations would you do for this man?

Answer 12

Palpation over abdomen; referral to GP

Question 13

7. Barry, a 63-year old retired bricklayer is assisted into your clinic with LBP with referral down the posterior aspect of the thigh. The pain commenced suddenly while gardening 5 days ago when he lifted a heavy pot which he estimates weighed 20 kgs. He describes the pain as sharp and shooting. He got only a minimum of relief lying on his back. He has type 2 diabetes and was recently diagnosed with benign prostatic hypertrophy. Since retirement, he has noticed a significant increase in his weight and a general decrease in muscle conditioning. Name three Differential Diagnoses and justify each.

Answer 13

• Disc herniation
• Chronic Prostatitis
• Prostate cancer with bone metastasis

Question 14

What examinations would you do for Barry?

Answer 14

Radiography

PSA blood count- MRI and PET scan with urologist

Question 15

8. John is a 60-year-old male who presents with a noticeable alteration in his usual cough. He has a 25-year history of a chronic cough, usually productive with white sputum. He has been a heavy smoker since the age of 20. He describes the change in his cough in terms of duration, now lasting all day rather than mornings only, of a deeper intensity and altered sputum colour to yellow-green. Name three Differential Diagnoses and justify each.

Answer 15

• Bacterial bronchitis
• Pneumonia
  (Cough/difficulty breathing/rapid heartbeat/fever/chest pain gets worse with breathing/fatigue/)

Question 16

What examinations would you do for John?

Answer 16

lungs; referral to hospital.

Question 17

9. Richelle, a 23-year old female, presents to your office with posterior left shoulder pain and weakness in the left shoulder. She reports landing on the posterior aspect of the left shoulder and upper arm after being thrown to the mat. . An anterior left shoulder dislocation was confirmed by radiography at the local ED. The dislocation was immediately reduced and she has not experienced any spontaneous re-dislocation since. The pain and swelling has dissipated, but she complains of experiencing persistent posterior shoulder pain. The pain is a constant burning sensation localised to the inferior half of the medial border of the left scapula. Name three Differential Diagnoses and justify each.

Answer 17

• Hills Sach lesion A Hill-Sachs lesion is an osseous defect or “dent” of the postero-supero-lateral humeral head that occurs in association with anterior instability or dislocation of the glenohumeral joint.
• Bankart lesion
  Bankart lesions are injuries of the anteroinferior aspect of the glenoid labral complex and are often found in association with a Hill-Sachs lesion. This injury is a common complication of anterior shoulder dislocation and/or repeated anterior shoulder subluxations. The dislocation of the shoulder joint (anterior) can damage the connective tissue ring around the glenoid labrum. It can also bring damage to the connection between the labrum and capsule.
• Capsular ligament avulsions

Question 18

What examinations would you do for Richelle?

Answer 18

Shoulder range of motion; referral for radiograph

Question 19

10. Paul is a 41-year-old man who presents with right forearm discomfort. He describes it as a dull ache and that the skin feels different. He explains that the arm symptoms seem better in the morning and get progressively worse through the day. His X-rays show moderate degenerative change at the C4-6 level. He has found that he can experience pain and tingling into the right arm associated with these problems Name three Differential Diagnoses and justify each.

Answer 19

Cubital tunnel syndrome (numbness and tingling can cause aching pain on inside of elbow.

Stress fracture in ulna

Posterior interosseus nerve syndrome

Radial nerve neuropathy

Cervical radiculopathy

Question 20

What examinations would you do for Paul?

Answer 20

ULND; referral for radiograph

Question 21

11. Martha is a 75-year old woman who presents with SOB. She notices this mostly when walking up a flight of stairs. She can walk slowly for about 10 minutes on a flat surface before becoming breathless. Occasionally She wakes up during the night with a feeling that she cannot get enough air into her lungs. When this happens, she gets out of bed and stands by her open window, which eventually eases that feeling. She states that she needs to be propped up in bed on three pillows to allow her to sleep comfortably. Martha has also noticed that her ankles get puffy by the end of the day, but they seem to be better by the next morning. However, sometimes she wakes with puffiness in her face or hands Name three Differential Diagnoses and justify each.

Answer 21

Core pulmonare
Pulmonary embolism
Atherosclerotic cardiac valve causing regurgitation

Question 22

What examinations would you do for Martha?

Answer 22

heart auscaltation; referral to GP

Question 23

12 Jessica is a 18-year old female who presents to the clinic with her mother. Jessica is reporting ‘groin’ pain, which is worse with running and kicking at AFL training and matches. Jessica reports the pain began approximately four (4) weeks ago and has become more severe over the past 1-2 weeks. The pain occurs mostly with running, changing direction, or when kicking. Name three Differential Diagnoses and justify each

Answer 23

Iliopsoas impingement
Sports hernia (Pubalgia)
Osteitis pubis

Question 24

What examinations would you do for Jessica?