PBL Case Discussion: Neurologic Disorders Part One (graded)
Setting: large urban city
Family practice clinic that employs physicians and nurse practitioners
It's been a quiet day at the clinic today. You move to the chart holder to get the chart for your next patient, Christopher D, who presents with the chief complaint of headache.
HPI: Christopher D is a 15-year-old boy who presents with his mother. Christopher D is sitting on the exam table playing on his phone. He does not look up when you enter. His mother Margaret rises from the chair to greet you. Christopher D looks up and smiles but returns to looking at the phone until his mother asks him to put the phone away. Christopher D appears his stated age and is well groomed. You pull up your exam stool in front of Christopher D to ask him why he is here today. "I get headaches, sometimes they last for days. Mom says all the time I spend on the computer and looking at my phone is causing them, but I don't think so."
PMHx: Christopher's mother reports his overall health as good.
Childhood/previous illnesses: None
Chronic illnesses: None
Surgeries: None
Hospitalizations: None, One urgent care visit three months ago for a mild concussion sustained during a tackle at the high school football game. No LOC at time of injury or after. No resulting neurological deficits.
Immunizations: Childhood immunizations up-to-date. Receives the flu shot every year.
Allergies: Seasonal
Blood transfusions: None
Denies ETOH, tobacco, illicit drugs
Sleep: Sleeps 5 to 6 hours a night. States "I can't fall asleep before 12:30 a.m. and I get up at 5 for football practice."
Current medications: None
Social History: Good student. Lives with parents and older sister and younger brother
Family History: Mother no health problems, father bipolar and well-controlled. Siblings in good health. MGM deceased from breast CA. MGF deceased: lung CA. PGM alive, 85, overall health good. Has Type 2 diabetes.
Discussion Questions Part One:
- List any further questions you have for Christopher and link them to their respective differential diagnosis.
- What are the three (3) most common, most likely differential diagnoses for this visit thus far with pathophysiology and evidence-based rationale? Please include the pertinent information from the case study that leads you to consider this diagnosis.
- Based on your differential diagnosis list, identify what body systems you will examine along with pertinent positive/negatives in each system and any diagnostic tests you would like to perform.
- List any relevant labs/diagnostic tests and link them to each diagnosis in the differential list. Remember to include evidence-based support for any testing you order along with rationale if you feel no testing is warranted.