Shadow Health Tina Jones HEENT Lifespan

Lifespan Activity Time: 26 min
Scenario: Tina’s Cousin with a Fever and Sore Throat
Tina has an eight-year-old cousin who has a high body temperature and a painful throat. What could be causing these symptoms? What kinds of examinations and tests should you conduct, and why?

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Student’s Answer:
In this situation, we need to consider various possibilities for the cause of the symptoms. These include viral throat infection, strep throat, influenza, a common cold, and sinusitis. To determine if it’s strep throat, we should perform a rapid strep test. Additionally, checking the lymph nodes in the neck can help identify any swelling or tenderness. Examining the throat is also crucial for making a diagnosis. If we see white pockets of pus and tiny red spots on the palate, it’s a sign of strep throat. However, if we only see redness, it might indicate a viral infection or postnasal drip. If there’s a discharge at the back of the throat, we should investigate for a runny nose and feel the sinuses in the appropriate manner based on the patient’s age. If pressing on the sinuses causes discomfort and the patient has had purulent nasal discharge for the past 7-10 days, it could be sinusitis. To exclude influenza, we can perform a rapid flu test.

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Scenario: Tina’s Great Aunt with Hearing Issues
Tina’s 76-year-old great aunt visits the clinic and frequently asks for things to be repeated. During the Rinne test, you notice that air conduction is better than bone conduction in her left ear. What might be causing these problems? What additional tests or assessments should you carry out?

Student’s Answer:
In this case, we need to consider sensorineural hearing loss and anatomical defects as possible causes. Sensorineural hearing loss is quite common in older individuals and can result from factors like genetics, diabetes, cerebrovascular diseases, exposure to loud noise, certain medications, high cholesterol, low thyroid function, and kidney problems. To make a more precise diagnosis, we should inquire about her hearing history and any previous ear injuries. It’s crucial to ask if she’s had chronic ear infections or any trauma that might have caused physical abnormalities in the ear. We can also examine her current and past medications to rule out medication-related hearing issues. To check for diabetes, we can measure fasting glucose levels and Hgb A1C. Thyroid function can be assessed with TSH and T4 levels. Kidney health can be evaluated using GFR or creatinine levels. Cholesterol levels, including triglycerides, HDL, and LDL, can help us rule out high cholesterol. Additionally, a neurological assessment can help identify any problems related to blood flow to the brain. If no specific cause is found, the hearing loss can be attributed to the natural aging process.

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?

Student Response:

Model Note: Differential diagnosis includes viral pharyngitis, strep throat, influenza, cold, and sinusitis. To rule out strep, a rapid strep is indicated. Palpation of the cervical lymph nodes may demonstrate enlarged, tender, cervical lymph nodes. Visualization of the throat also gives clues to the diagnosis. White pus pockets and petechiae on the palate are classic signs of strep throat. Erythema alone may indicate viral infection or postnasal drip. If purulent discharge is noted in the posterior pharynx assess for nasal discharge and palpate the appropriate sinuses for the patient’s age. If palpation elicits pain and purulent nasal discharge is reported over the last 7-10 days, consider sinusitis. A negative rapid flu test would rule out influenza.

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?

Student Response: Model Note: Differential diagnosis includes sensorineural hearing loss and anatomical defects. Sensorineural hearing loss is common in old age and can be caused by heredity, diabetes, cerebrovascular disease, excessive noise, ototoxic medications, hyperlipidemia, hypothyroidism, and renal failure. Assessments should include a history of hearing impairment and ear injuries. It is important to inquire about chronic ear infection or other trauma that leads to anatomical abnormalities. 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.

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Shadow Health Tina Jones HEENT Lifespan