Shadow Health Assignments
Tina Jones Neurological Shadow Health Lifespan
Lifespan Activity Time: 29 min
Tina’s three-year-old neighbor comes to the clinic with a fever, neck pain, headache, and confusion. He doesn’t show signs of an upper respiratory infection. His parents say they don’t believe in vaccines. What’s the most worrying diagnosis? What should you do next?
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Student Response: The neighbor has xxx, but we should be concerned about bacterial meningitis. Not getting vaccines makes him more likely to get meningitis from Haemophilus influenza type B. It’s important to note that xxx, he doesn’t have a history of long-lasting infections. Children with strep throat can have neck pain and fever, but they won’t be confused. So, the first step is to do a spinal tap to check for meningitis. He should also get broad-spectrum antibiotics right away. Since this is urgent, take him to the emergency room for immediate care.
Model Note: We need to rule out bacterial meningitis right away. Not getting vaccines makes him more likely to get meningitis from Haemophilus influenzae type B. Seizure disorder doesn’t cause fever. Although kids with immunodeficiency syndrome are more prone to meningitis, this child hasn’t had ongoing infections. Children with strep throat might have fever and neck pain, but they won’t be confused. He needs a spinal tap to figure out the type of meningitis and antibiotics should start quickly. He should be taken to the emergency room.
Tina’s 83-year-old great uncle gets confused during his yearly check-up. He can’t remember if he’s had memory problems before and he came alone. List what could be causing this and what tests should be done.
Student Response: Dementia, an electrolyte problem, a stroke, infection, transient ischemic attack, dehydration, and xxx are possible reasons. The healthcare provider should do a neurological assessment to check for transient ischemic attack and dementia. Also, look at his mucous membranes and skin for dehydration. Test his urine to see if he has a urinary tract infection, which often confuses elderly people. More info is needed, so ask him about his medicine and memory. If he’s completely confused, get in touch with family members for more info.
Model Note: The possibilities include stroke, transient ischemic attack, dementia, infection, electrolyte imbalance, dehydration, and drug side effects. A neurological assessment is needed to rule out stroke and TIA. Check mucous membranes and skin for dehydration. Do a urine test for a urinary tract infection, a common cause of confusion in older people. Ask about his meds and health history if he can remember. If he’s very disoriented, get in touch with family members for more info.
LifespanActivity Time: 29 min
Tina’s three-year-old neighbor presents to the clinic with fever, neck pain, headache, and confusion. He has no symptoms of an upper respiratory infection. The parents mention that they do not believe in immunizations. Based on the information given, what diagnosis is of the greatest concern? What is your next action?
Student Response: the neighbor has xxx, bacterial meningitis should be ruled out because immunizations put one at an increased risk for meningitis from Haemophilus influenza type B. It is important to note xxx, has no history of chronic infection. Children presenting with strep throat will have neck pain and fever, however, they are oriented and not confused, and therefore, this three-year-old patient will need an immediate spinal tap that will help in determining the nature of meningitis and will be started on a broad spectrum of antibiotics and because this is an emergency, he should be taken to an emergency room where he can get immediate care.
Model Note: Bacterial Meningitis needs to be ruled out immediately. He has not had immunizations which puts him at increased risk for meningitis from Haemophilus influenzae type B. Seizure disorder does not cause fever. Children with immunodeficiency syndrome are at increased risk for meningitis but this child has no previous history of chronic infections. Although children with strep throat can present with fever and neck pain, they are not confused. He needs an immediate spinal tap to determine the nature of the meningitis, and broad spectrum antibiotics should be started as soon as possible. He should be sent to the emergency room.
Tina’s 83-year-old great uncle forgets where he is during his yearly check-up. He doesn’t remember if he’s had memory problems before and no family members came to your office with him. List your differential diagnosis. What assessments would you perform?
Student Response: Dementia, electrolyte imbalance, stroke, infection, transient ischemic attack dehydration, and xxx differential diagnoses for this patient and therefore, a healthcare provider attending to him should conduct a neurological assessment that will help in ruling out transient ischemic attack and dementia. additionally, mucus membrane visualization and skin assessment for tenting will be done to help rule out dehydration while urinalysis will be performed to help in ruling out urinary tract infection which is a known common cause of confusion among elderly patients. More information about the patient will be needed and therefore, he will be asked some questions about his medication to check his memory and obtain information and if he is completely disoriented, his immediate family members will be used to obtain the required information.
Model Note: Differential diagnosis includes stroke, transient ischemic attack, dementia, infection, electrolyte imbalance, dehydration and drug toxicity. The provider should do a neurological assessment to rule out stroke and TIA. Visualization of mucous membranes and skin assessment for tenting is indicated to rule out dehydration. A urinalysis should be performed to rule out a urinary tract infection which is a common cause of confusion in the elderly. He should be asked questions about his medication intake and medical history in case he retains some memory. If he is completely disoriented, family members should be contacted, if possible, to gain more information.
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