What additional differential diagnosis is appropriate for our first patient, based on the S/S?
Week 2/Discussion 2/ my post
While interviewing and examining a 17-year-old male, you discover a white patch on his buccal mucosa and slanting palpebral fissures in his eyes. He also states during the interview that he plays baseball and is hoping to earn an athletic scholarship to college.
When the 17-year-old boy says he plays baseball and would like to get an athletic scholarship for college, we can suspect that he spends a lot of time in the field, exposed his self to sun and has been exposed to smokeless tobacco which is prevalent in the baseball sport. An increased use of smokeless tobacco use in sports, mainly in baseball is been reported in 2016 (Jarvis, 2016). ), “Leukoplakia is chalky white, thick raised patch with well-defined borders.” This is attached firmly to the buccal mucosa, even if you scraping hard it will not come off. You can also see it in individual who are heavily tobacco user as well as alcohol (Jarvis, 2016). White patches in the mouth also called excessive Candida you may see it in patient with weak immune system, steroid inhaler user, and HIV infection, use of broad-spectrum antibiotics, leukemia, and malnutrition.Slight upward or downward slanting of palpebral fissures normally occurs on a familial basis or in groups such as people of Asian descent. So in this case the slating palpable fissures in his eyes found during the assessment can be suspect that this patient is Asian or is an Asian descent. In non-Asians, the palpebral fissures are horizontal (Jarvis, 2008). Usually when narrowed, upward slanted palpebral fissures are present it could be indication of Down syndrome. In this case this 17-year-old boy should have been ruled out earlier than the age of 17. I would conduct a cranial nerve examination using Snellen chart test for visual acuity to see if there are any deficits in the optic nerve. Patients near vision could also be assessing (Jarvis, 2016). An ophthalmoscope consult should be place to “examine the ocular fundus to determine the color, size, and shape of the optic disc” (Jarvis, 2016, p. 644). I will also get order for a CT scan to rule out ICP if during retina exam patient’s margins of the optic disc become blurred and indistinct. I would first want to initially suspect that the patient has papilledema, also known as a choked disc which is an increase in cranial pressure (ICP) (Jarvis, 2016).
As a Health care professionals we are educated and trained on strategies to teach patients and family members about this condition. First and foremost, would be for the patient to have genetic testing done to confirm a Down syndrome diagnosed. If the test results are positive, then the health care professional can provide the family and patient with the appropriate resources and specialty professionals to aid them in coping with their new diagnosis. The one most important thing that a health care professional can do is to empower the patient and family. This can be accomplished by carrying out interventions in a manner in which family members acquire a sense of control over their own efforts to meet their needs. Health care professionals can also enable families by creating opportunities for family members to become more competent and self-sustaining with respect to their abilities to mobilize their social networks to get their needs met and attain desired goals (Cohen, 2013). It is important to also let the patient know that his career of playing baseball may be limited in college may grossing diminish if other manifestations of condition sets in later in life.
Some special considerations that can help to educate the patient and family on health promotion and disease intervention would include continuous monitoring measures, including yearly audiologic assessment and yearly ophthalmologic assessment, ongoing management of manifestation of the disorder and related conditions, as well as discussion of issues identified with the move into adulthood. If it were discovered that the patient has developed the habit of using smokeless tobacco, I would educate him on the harmful effects of smokeless tobacco such as the increase risk for cancer, and encourage him to seek out measures to quit. I would also remind him that at the age of 17 it is illegal to obtain to tobacco products and that he could jeopardize his chances of playing baseball on the collegiate level via an athletic scholarship if caught breaking the law. Furthermore, I would encourage this patient to seek alternative measure to quit smoking, and pick up healthier habits like chewing sugar free gum in place of using smokeless tobacco.
Cohen, W. I. (2003). Health Care Guidelines for Individuals with Down Syndrome-1999 Revision. Down Syndrome, 237-245. doi:10.1002/0471227579.ch17
Jarvis, C. (2016). Physical examination & health assessment. (7th ed.). St. Louis: Elsevier.
Jarvis, C. (2008). Pocket companion for physical examination and health assessment. (5thed.). St. Louis: Elsevier.
PROFESSOR QUESTION/NEEDS TO ANSWER TO PROFESSOR BASE ON MY POST.
For our 1st pt-
The diagnosis of whiplash is a key differential diagnosis for our first patient. When we consider the patients complaints; HA, decreased ROM in the neck, vertigo, loss of hearing to one ear, sweating and uncontrollable eye movements, along with the recent possible mechanism of injury; the MVA whiplash does fit a possible diagnosis for this patient. When we think of the causes of whiplash, we think of a force strong enough to whip the patients neck backward and forward, placing a great deal of stress on the neck muscles and ligaments. What additional differential diagnosis is appropriate for our first patient, based on the S/S?