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18 YEAR OLD PATIENT REASON FOR ENCOUNTER : PASSED OUT WEEK 7 I HUMAN CASE (CLASS 6512) C, Exams of Community Health

18 YEAR OLD PATIENT REASON FOR ENCOUNTER : PASSED OUT WEEK 7 I HUMAN CASE (CLASS 6512) CASE 2025 18 YEAR OLD PATIENT REASON FOR ENCOUNTER : PASSED OUT WEEK 7 I HUMAN CASE (CLASS 6512) CASE 2025

Typology: Exams

2024/2025

Available from 01/09/2025

anjimurimi254
anjimurimi254 🇬🇧

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18 YEAR OLD PATIENT REASON FOR ENCOUNTER :

PASSED OUT WEEK 7 I HUMAN CASE (CLASS 6512)

CASE 2025

1. Patient Information (Expanded)Age : 18 years old.  Gender : Male.  Height : 6’0” (183 cm).  Weight : 222.0 lbs (100.9 kg).  BMI : Calculate to assess whether obesity is a factor. o BMI = Weight (kg) / Height² (m²).  Chief Complaint : Passed out (syncope).  Context of Syncope : o Where was he (e.g., standing, sitting)? o Was the episode witnessed? o Any associated trauma during the event? Other Patient Demographics to consider:  Race/ethnicity (if relevant to hereditary conditions).  Occupation/student (to assess stress, fatigue, or sleep deprivation). 2. History Questions (Expanded)

History of Present Illness (HPI): Detailed exploration of the syncope episode:

  1. Before the event: o What were you doing before you passed out? o Did you experience any warning signs (e.g., dizziness, lightheadedness, nausea, blurred vision, sweating, palpitations)? o Was there any sudden onset chest pain, shortness of breath, or headache?
  2. During the event: o How long did the episode last? o Did you lose consciousness completely, or was it a near-syncope episode? o Any muscle jerking or tongue biting (indicating seizure)?
  3. After the event: o How did you feel after regaining consciousness (e.g., confusion, fatigue)? o Were you able to stand or walk afterward? o Did anyone report observing changes in your skin color (e.g., pale, cyanosis)?
  4. Injury Details: o Did you hit your head or sustain any injuries during the fall? o Any bruising, swelling, or bleeding? Past Medical History (PMH):  Have you ever fainted or passed out before?

 Any known medical conditions (e.g., hypertension, diabetes, arrhythmias)?  Previous diagnoses of seizures or neurological conditions? Medications and Allergies:  Are you currently taking any prescription medications, over-the- counter drugs, or supplements? o Focus on diuretics, antihypertensives, or antidepressants.  Any recreational drugs or excessive caffeine/alcohol consumption?  Known allergies? Family History (FH):  Is there a family history of: o Heart disease or arrhythmias? o Sudden cardiac death at a young age? o Neurological disorders (e.g., epilepsy)? Social History (SH):  Do you consume alcohol, tobacco, or other substances?  Are you under stress, sleep-deprived, or experiencing emotional disturbances?  Physical activity level and diet quality? Review of Systems (ROS):

General : Weight loss, fever, fatigue.  Cardiovascular : Palpitations, chest pain, leg swelling.  Neurological : Headache, weakness, confusion, memory loss.  Endocrine : Polyuria, polydipsia (signs of diabetes).  Psychiatric : Anxiety, depression.

3. Physical Exam (Expanded) General Appearance:  Does the patient appear pale, anxious, or diaphoretic?  Is he alert and oriented? Vital Signs:  Blood pressure (supine, sitting, and standing to assess for orthostatic hypotension).  Heart rate and rhythm.  Respiratory rate and oxygen saturation.  Temperature (if infection suspected). Focused Examination: 1. Cardiovascular Exam: o Check heart rate, rhythm, and murmurs (e.g., aortic stenosis). o Auscultate for signs of heart failure (e.g., S3 gallop). o Assess for peripheral pulses and edema. 2. Neurological Exam: o Cranial nerve function, motor strength, reflexes, sensation, and coordination.

o Test for nystagmus or gait instability.

  1. Head and Neck: o Check for trauma (e.g., bruising, swelling). o Look for jugular venous distension.
  2. Skin: o Check for cyanosis, petechiae, or pallor. o Evidence of injuries from a fall. 4. Assessment/Tests (Expanded) Basic Investigations:ECG : Rule out arrhythmias (e.g., atrial fibrillation, QT prolongation).  Orthostatic Vital Signs : Diagnose orthostatic hypotension.  CBC : Look for anemia or infection.  BMP : Electrolytes, renal function, and glucose.  Blood Glucose : Immediate point-of-care testing for hypoglycemia. Advanced Tests (if indicated):Echocardiogram : Structural heart abnormalities (e.g., hypertrophic cardiomyopathy).  Holter Monitor : If intermittent arrhythmias are suspected.  CT or MRI of the Brain : Rule out structural neurological abnormalities.  EEG : If seizures are suspected. 5. Differential Diagnosis (Expanded)

Primary Diagnoses to Consider:

  1. Vasovagal Syncope: Triggered by prolonged standing, stress, or dehydration.
  2. Orthostatic Hypotension: Often related to dehydration or medication.
  3. Cardiac Syncope: Arrhythmias (e.g., atrial fibrillation, ventricular tachycardia) or structural abnormalities (e.g., aortic stenosis).
  4. Neurological Syncope: Seizures, transient ischemic attack (TIA).
  5. Hypoglycemia: Especially if diabetic or fasting. Differentiating Clues:  Vasovagal: Preceded by lightheadedness, sweating, or nausea.  Cardiac: Sudden, without warning.  Neurological: Postictal confusion or tongue biting. 6. Plan (Expanded) Immediate Actions:  Stabilize the patient (monitor vitals, provide IV fluids if dehydrated).  Address any critical conditions (e.g., glucose correction). Diagnostic Workup:  Order ECG, labs, and orthostatic measurements.  Perform imaging or advanced tests based on initial findings. Treatment Plan:  Treat underlying cause (e.g., fluids for dehydration, medication adjustments).  Lifestyle advice: Avoid triggers (e.g., standing quickly, dehydration).

Follow-Up and Referrals:  Schedule follow-up with a cardiologist or neurologist.  Educate the patient about warning signs and when to seek immediate care. Subjective: Identifying Information:Age: 18 years  Gender: Male  Height: 6'0" (183 cm)  Weight: 222.0 lb (100.9 kg)  BMI: [To be calculated, approximately 30.5 (indicates obesity)] Chief Complaint (CC): "I passed out." History of Present Illness (HPI): The patient reports that he lost consciousness earlier today. He states the following:  He was standing in line for a prolonged period before fainting.  Felt lightheaded and nauseated before passing out.  No preceding chest pain, shortness of breath, or headache.  Episode lasted less than a minute, and he regained consciousness spontaneously without confusion.  No reported tongue biting or involuntary movements during the episode.  He hit his elbow during the fall but denies head injury or significant trauma.

 First episode of this kind. Associated Symptoms:  No fever, fatigue, or recent weight loss.  No palpitations or irregular heartbeats.  No visual changes or neurological deficits. Past Medical History (PMH):  No history of syncope, seizures, or cardiac conditions.  No diagnosed chronic illnesses. Medications:  None reported. Allergies:  None known. Family History (FH):  No family history of heart disease, arrhythmias, or sudden cardiac death.  No family history of epilepsy or neurological disorders. Social History (SH):  Non-smoker.  Does not drink alcohol or use recreational drugs.  High school student with moderate stress levels from academics.  Reports a sedentary lifestyle and frequent consumption of fast food. Review of Systems (ROS):General: No fever, chills, or recent illness.

Cardiovascular: No chest pain, palpitations, or edema.  Neurological: No weakness, numbness, or confusion.  Endocrine: No excessive thirst or urination.  Psychiatric: No depression or anxiety reported. Objective: Vital Signs:  Blood Pressure: 118/76 mmHg (supine), 96/64 mmHg (standing) — positive orthostatic hypotension.  Heart Rate: 82 bpm (supine), 96 bpm (standing).  Respiratory Rate: 16/min.  Temperature: 98.6°F (37°C).  Oxygen Saturation: 98% on room air. General Appearance:  Alert, oriented, appears well-nourished, but mildly anxious. No acute distress. Focused Physical Examination:

  1. Cardiovascular: o Regular rate and rhythm. o No murmurs, gallops, or rubs. o Peripheral pulses strong and symmetric. o No jugular venous distension.
  2. Neurological: o Cranial nerves II-XII intact.

o Strength 5/5 in all extremities. o Normal reflexes. o No focal deficits or signs of postictal confusion.

  1. Head and Neck: o No head trauma, bruises, or swelling noted. o Neck supple with no lymphadenopathy or carotid bruits.
  2. Skin: o Warm, dry, no cyanosis or pallor. o Minor abrasion noted on left elbow. Assessment/Plan: Assessment: An 18-year-old male presenting with a single episode of syncope, most likely due to vasovagal syncope precipitated by prolonged standing. Positive orthostatic changes noted on examination suggest dehydration may also contribute. Cardiac and neurological causes appear less likely at this time. Differential Diagnosis:
  3. Vasovagal syncope (most likely).
  4. Orthostatic hypotension due to dehydration.
  5. Cardiac arrhythmia (e.g., bradycardia, ventricular tachycardia).
  6. Neurological causes (e.g., seizure, TIA).
  7. Hypoglycemia or other metabolic disturbance. Plan:
  8. Immediate Management:

o Educate the patient on lying down if lightheadedness occurs again. o Advise adequate hydration and electrolyte replenishment.

  1. Diagnostic Workup: o ECG: Rule out arrhythmias or conduction abnormalities. o CBC: Evaluate for anemia or infection. o BMP: Assess for electrolyte imbalances or renal dysfunction. o Orthostatic Vital Signs: Already positive for hypotension.
  2. Follow-Up: o Schedule follow-up with primary care physician for further evaluation if symptoms recur. o Consider referral to cardiology if ECG abnormalities or recurrent episodes occur.
  3. Lifestyle Modifications: o Encourage increased water intake (8- 10 glasses/day). o Recommend regular meals with balanced electrolytes and reduced fast food consumption. o Suggest moderate physical activity to improve cardiovascular tone. Patient Education:  Educated the patient on vasovagal syncope, triggers, and preventive strategies.  Advised to avoid prolonged standing, especially in hot environments.

 Discussed red flag symptoms such as chest pain, persistent palpitations, or recurrent fainting episodes, requiring immediate medical attention.