Diff. Diagnosis Practice

[Cooper1186]

What's everyone's input? SAH?

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[hanz504]

My ddx would include TIA, vasovagal syncope, SAH, ICH, arrhythmia

 

[Apoplexy__]

My ddx would include TIA, vasovagal syncope, SAH, ICH, arrhythmia

This, plus a tumor (posterior fossa?).
My #1 Dx is probably a ruptured aneurysm as the cause of the SAH, not trauma. Especially because of the following:
-Current high BP
-Extremely high risk of atherosclerosis and CV disease (HTN, DM, etc. in both history AND family history)
-Recent cessation of BP meds

 

[Instatewaiter]

Why doesn't this guy already have a head CT?

Sh.t, you cough funny in my ED and you get both a PE protocol CT and a head CT.

 

[oingoboingo]

My working dx would be ruptured aneurysm - because of current HTN, history of HTN, and PCKD.
DDX vasovagal syncope, TIA

 

[VisionaryTics]

I'd throw situational syncope in there. Sits on the crapper, strains, drops his pre-load and syncopes.

 

[Microshaft]

I would probably syncope myself if I ever picked up a pt file with all that info but no ECG or head CT

 

[notbobtrustme]

i don't know what's going on here

 

[evilbooyaa]

#1 R/o Dx HAS to be a SAH d/t ruptured berry aneurysm. If you miss this, patient dies.
Reasons:
Hx of Polycystic Kidney Dz
High BP + Not on BP meds
Neck Pain + TTP posteriorly without evidence of trauma
"Headaches intermittently, has not seen a neurologist. This headache is different."

DDx includes - TIA (FHx of CVA + Pt's BP), Vasovagal, situational syncope (as VT said), Maybe a tumor (idk if I would include that on an official list).

For practice, that's what you do. In real life someone would come in with syncope + head pain, get a head CT to r/o a bleed in the ED, then go on with rest of the workup.

 

[TooMuchResearch]

I'd throw situational syncope in there. Sits on the crapper, strains, drops his pre-load and syncopes.

Yeah, my thoughts were 1) Where is the CT read? and 2) Didn't this guy have to poop or was pooping?

 

[GangaMaster]

 

[Rendar5]

Diagnosis = Admit