Case Study
The patient in the present case is E.B. – a 21-year old female who had arrived at the hospital with the following chief complaint: “I feel sick”. There was a set of symptoms displayed by the patient that came along with her main complaint. During the assessment, the patient was inquired about her other symptoms, their nature, the level of severity, their perceived causes, the factors that aggravated them, or made them go away, the treatments she might have applied, and the period for which she has been experiencing these symptoms.
According to the patient’s statement, she had suffered from a cough attack two weeks ago. She had believed that the cough was caused by flu which went away after a while; however, she started feeling worse again. The patient reported that she still had a fever, felt shaky, occasionally had a nonproductive cough, shortness of breath, heart skipping, and vomiting that started last night. She reported noticing no blood in the vomit, only food.
In addition to these symptoms, the patient mentioned an ongoing feeling of anxiety and a loss of sleep that she tied to her recent break up with her boyfriend. Also, the patient was inquired about such symptoms as the production of sputum during cough, headache, and dizziness – she denied all of them and said that she did not take any drugs. She mentioned that during her cough attack two weeks ago she took Tylenol because she believed this was the flu; and she did not take any cough medication at all.
The visual observations made during the physical exam revealed that the patient was sweating excessively, and her breath was heavy and interrupted; the overall behavior of the patient pointed to a high level of stress and nervousness; she appeared tense, restless, jittery, and impatient. She made several attempts to speed up the process of assessment and rush her treatment. Her responses to the assessment questions were short and brief.
The physical examination had to be focused on the systems connected to the patient’s major complaint and symptoms; these were her abdomen (due to vomiting and nausea), lungs, thyroid, and heart (heavy breath, elevated heartbeat, and heart skipping), skin, head, ears, nose, and eyes due to excessive sweating), and mouth and throat (because of coughing). The examination revealed tachycardia (150 beats per minute) with an irregular pulse, as well as systolic hypertension (160), accompanied by palpitations, anxiety, and tremor; also, the patient reported increased appetite and a loss of weight, hyper defecation, fever, fatigue, and insomnia – these symptoms are the signs of hyperthyroidism (Kravets, 2016; Ross et al., 2016).
E.B seems to be affected by one of the complications that can occur in hyperthyroidism is thyrotoxicosis – a condition that leads to more serious health risks (Sayin, Ertek, & Cesur, 2014). Also, it can be suspected that E.B. is affected by Grave’s disease that is characterized by hyperthyroidism and a ropey isthmus that the patient also had (American Thyroid Association, 2017; De Groot, 2015).
Moreover, the patient’s symptoms (nausea, fever, cough, fast rate of breathing) also point to the potential of pneumonia acquired due to living in a dorm and being surrounded by other students; however, E.B. denied sputum production, dizziness, and headache – the other typical symptoms of this condition (Scott et al., 2013). To sum up, the differential diagnoses for this case are thyrotoxicosis, community-acquired pneumonia, and intoxication by drugs. The differentials identified for this case were elevated heartbeat, rapid breathing rate, suspected influenza, and dehydration. However, with the inclusion of the abnormal activity in the patient’s thyroid mentioned in the case study, the final diagnoses include community-acquired pneumonia and thyrotoxicosis.
References
American Thyroid Association. (2017). Grave’s disease. Web.
Kravets, I. (2016). Hyperthyroidism: Diagnosis and treatment. American Family Physician, 93(5), 363-370. Web.
Ross, S. D., Burch, H. B., Cooper, D. S., Greenlee,C., Laurberg, P., Maia, A. L.,… Walter, M. A. (2013). 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid, 26(10), 1343-1421. Web.
Sayin, I., Ertek, S., & Cesur, M. (2014). Complications of Hyperthyroidism. In Soto, G.D. (Ed.), Thyroid disorders – focus on hyperthyroidism (65-140). Hampshire, England: InTech. Web.
Scott, J. A., 2 Wonodi,C., Moisi, J.C., Deloria-Knoll, M., DeLuca, A. N., Karron, R. A., … Feikin, D. R. (2012).The definition of pneumonia, the assessment of severity, and clinical standardization in the pneumonia etiology research for child health study. Clinical Infectious Diseases, 54(2), 109–116. Web.