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Med School Students: Case Study #2

Med School Students Case Study 2

A 47 year old woman has been admitted to the hospital with abdominal pain, and fairly advanced jaundice. What questions would you ask to properly diagnose her? What assumptions would you make?

Symptom Exploration

Originally, the patient indicated that her only symptoms were her off-color skin and a pain in her right side. As admitting physicians probe further, they discover much more. Would you have asked the right questions?

It took two or three rounds of questioning about her intestinal health to learn that her urine had turned brown and her bowel movements had been, in her words, “pale.” And, while she said she’s felt fine for a while, when pressed, she admits that the pain on her side actually began a few months ago, and has progressed to episodes that occur a couple of times a day and are often bad enough to keep her in bed.

The woman who initially said she “wasn’t feeling that bad,” also eventually mentions, after an intensive interview,, that she hasn’t been eating because it is too painful, and that her current pain level is at a 7 out of 10.

Additional Information

What additional information would you need to make a diagnosis? During their initial examination, doctors found no significant abdominal distension and no masses. There was tenderness in upper right quadrant, and the Murphy’s sign was +ve. Percussion tenderness is present, along with bowel sounds. Doctors rule out gallstones via Courvoisier’s law. The patient also has periumbilical bruising and bruising on her flank.

  • Do you know why Courvoisier’s law is pertinent in this case?
  • Would you have known to test for Murphy’s Sign? Do you know what Murphy’s Sign is?
  • Do you know what Cullen’s sign and Grey Turner’s signs are? She has both.

In addition to the results of the initial examination, we can assume that the patient has under-reported her symptoms because during the course of the examination her symptoms have gone from being just a couple of weeks old, to a couple of months old. She’s gone from feeling pretty well, to not being able to get out of bed on some days. And, she’s gone from having no additional symptoms, to having a whole host of them.

Diagnosis

Based on these symptoms, what is your differential diagnosis?

  1. Pancreatitis
  2. Coledocholithiasis
  3. Cholecystitis

The final diagnosis was acute cholecystitis. Was that your diagnosis? What would you do to confirm that diagnosis? Do you know what blood tests to order and imaging to perform? Can you name them all from memory? No? Well, that’s why you’re in medical school. There are at least 23 different blood results that could be diagnostic factors. No wonder you don’t know them all. What you may not know, is that you could have them all at your fingertips, available to you all day, every day, with every patient.

Part 3 Alternative Careers For MD’s CTA

Get an Edge

Get the edge you need to learn faster and retain more information with the XebraPro Clinical Diagnostic App. It would have helped you make an initial diagnosis, order the right tests, and know what the short and long-term courses of treatment for this case. The more you use it, the more your confidence will grow, and the more you’ll be able to retain.

Download the XebraPro App from iTunes or Google Play. It is free for students.

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