Diagnostic Reasoning Symptom Assignment

Diagnostic Reasoning Symptom Assignment
Student Name: Kristy Anderson
Symptoms: 55 year old male presents to your clinic with and upset stomach and belching past several months.
A. Identify the appropriate history questions to be asked of your patient to discriminate critical characteristics about the above presented concern.
1. Can you identify when exactly the upset stomach started?
2. Describe the upset stomach. Describe the pain. On a scale of 1/10 how painful is it?
3. Is the pain constant or does it come and go?
4. When you belch does it relieve the stomach symptoms?
5. Are you able to point to the pain or is it generalized pain?
6. Does the pain travel anywhere else?
7. Is there anything that makes your stomach feel better? Is there
…show more content…
GI: Heartburn, regurgitation, fullness, pressure, N/V/D/C?
29. Neuro: Any weakness, numbness tingling, incoordination?
30. Skin: Any bruises, changes is color, rashes, or new lesions?
31. Psych: Any depression, anxiety, stress, insomnia, hyperinsomnia, suicide ideations.

B. B. Identify 4 hypotheses that could support the above symptom in relation to pertinent answers given in the history. Given the patient symptoms, list hypotheses from most (1) to least likely (4) (Differential Diagnosis).
1 GERD: This is a 55 year old male. C/O upset stomach and belching.
1. The onset it vague. Not really getting worse or better.
2. The pain in described as burning, like heart burn pain rated 5/10.
3. Pain comes and goes.
4. The belching really doesn’t relieve the symptoms.
5. Can’t point to any exact area on the stomach.
6. The pain moves up from his stomach into his chest.
7. He says that tums helps for a while. Also standing up and walking around. It is worse after a meal when he sits in recliner or goes to bed. Or when he bends forward.
8. Appetite has not changed. He eats bacon and eggs for breakfast, Whooper and coke at lunch and nachos for dinner with ice cream.
9. This discomfort is more after he eats.
10. No food
…show more content…
Choose one hypothesis and write a PICO question. (PICO= Patient, Intervention, Comparison and Outcome)
GERD: In 55 year old males, how do H2 blockers compared to PPIs in the treatment of GERD initially.
G. Perform a search for evidence using the PICO search terms. Use Foley Library resources and describe the search strategy: terms entered, databases searched, number of hits obtained, any search limits placed on the search (e.g. peer-reviewed articles only or dates of publication, etc.). Consider using the Cochrane Library to find a systematic review.
I went to the Foley library and typed in the term “Gastroesophageal Reflux Disease.” I then narrowed it down by adding search limits which included “male,” “Peer Reviewed,” “Proton-Pump Inhibitors,” “Omeprazole,” and the dates 2010 to 2015. That yielded 470 articles. Out of that 470, two discussed the use of PPIs and H2 Blockers, only one was a true study. Next I did a Cochrane library search, I used the Mesh “Gastroesophageal reflux disease,” and modifiers (Proton-pump inhibitor and H2 blockers). This yielded 18 studies. Only one was beneficial to my topic.
H. Identifies one new study and describe the type of study (RCT, cohort study, descriptive study or etc.), the size of the sample, and the level of evidence for such a

Related Documents