Shadow Health Tina Jones HEENT Lifespan
Tina’s cousin who is eight years old comes with a fever and a sore throat. What are the possible reasons for these symptoms? What checks and tests would you do and why?
Student’s Answer:
Detailed Diagnosis: Possible causes include a viral infection in the throat, strep throat, flu, common cold, or sinus infection. To confirm or eliminate strep throat, a quick strep test is recommended. Feeling the lymph nodes in the neck can reveal if they are swollen and tender. Looking into the throat can also help with diagnosis. White patches or small red spots on the roof of the mouth are typical signs of strep throat. Just redness may suggest a viral infection or mucus dripping from the back of the nose. If there’s thick discharge at the back of the throat, we would check for nasal discharge and press on the sinuses appropriate for the patient’s age. If pressing on the sinuses hurts and the patient has had thick nasal discharge for the past 7-10 days, sinusitis could be considered. A negative result on a quick flu test would mean it’s not influenza.
Tina’s great aunt, who is 76 years old, visits the clinic and often asks for things to be repeated. During the Rinne test, it’s noticed that she hears better through the air than through the bone in her left ear. What could be causing these issues? What other checks would you do?
Student’s Answer:
Detailed Diagnosis: Possible reasons include nerve-related hearing loss and physical defects. Hearing loss due to nerves is common as people age and can happen due to genetics, diabetes, issues with blood flow to the brain, loud noises, medications that harm the ears, high cholesterol, low thyroid function, or kidney problems. We would ask about past ear issues or injuries. It’s crucial to know if there have been chronic ear infections or accidents that might have caused physical changes.
To exclude the possibility of medication causing ear damage, we’d review her current and past medications. Blood sugar levels after fasting and Hgb A1C can show if she has diabetes. Thyroid hormone levels can indicate if her thyroid is functioning properly. Tests for kidney function like GFR or creatinine levels can tell us about her kidney health. Cholesterol levels can indicate if she has high cholesterol. A neurological check can help rule out problems with blood flow to the brain. If no clear cause is found, we may conclude that her hearing loss is just due to old age.
Shadow Health Tina Jones HEENT Lifespan
Activity Time: 26 min
Tina’s eight-year-old cousin comes in with a fever and sore throat. What is your differential diagnosis? What assessments and tests would you perform and why?
Tina’s 76-year-old great aunt comes into the clinic for a visit and you find that she frequently asks you to repeat what you say. During the Rinne test, you find that air conduction is greater than bone conduction in her left ear. What is your differential diagnosis? What additional assessments would you perform?
An analysis of Tina’s great aunt’s medications and past medications can be used to rule out ototoxicity. Fasting glucose levels and Hgb A1C can be tested to rule out diabetes. TSH and T4 levels can rule out hypothyroidism. GFR or creatinine levels can rule out renal failure. Triglycerides, cholesterol, HDL, and LDL levels can be used to rule out hyperlipidemia. A neurological assessment should be completed to rule out cerebral ischemia. If no concrete diagnosis is made, the hearing loss should be attributed to old age.
