Shadow Health Assignments
Shadow Health Tina Jones HEENT Lifespan
Lifespan Activity Time: 26 min
Tina’s cousin, who is eight years old, arrives with a fever and a sore throat. What could be causing these symptoms? What tests would you do to find out?
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Student’s Answer:
Model Note: The possible causes are viral pharyngitis, strep throat, influenza, cold, and sinusitis. To check for strep, a rapid strep test is needed. Feeling the lymph nodes in the neck could show if they’re swollen and painful. Looking at the throat can also help diagnose. White pockets of pus and red spots on the palate suggest strep throat. Redness alone might mean a viral infection or mucus dripping down the throat. If there’s pus in the back of the throat, checking the sinuses for tenderness would help, especially in younger patients. If there’s pain and pus in the nose for 7-10 days, it might be sinusitis. A negative rapid flu test would rule out the flu.
Tina’s great aunt, who is 76 years old, visits and often asks you to repeat things. During the Rinne test, her left ear shows that she hears better through the air than through the bone. What could be causing this? What else would you check?
Student’s Answer:
Model Note: The possible causes are sensorineural hearing loss and anatomical issues. Hearing loss is common in older people due to things like genetics, diabetes, blood vessel problems, loud noises, certain medicines, high cholesterol, thyroid issues, and kidney problems. We should ask about her hearing history and any ear injuries. It’s important to ask about any past ear infections or injuries that might have caused changes in the ear’s structure. We could check her medications, both current and past, to see if any could have affected her hearing. Checking her blood sugar and HbA1c levels can tell us if diabetes is the cause. Testing her thyroid hormone levels can rule out thyroid problems. Checking her kidney function can rule out kidney problems. We can also check her cholesterol levels to see if high cholesterol might be related. A neurological exam can help rule out problems in the brain. If we don’t find a specific cause, we might attribute the hearing loss to aging.
Life span Activity Time: 26 min
Tina’s eight-year-old cousin comes in with a fever and sore throat. What is your differential diagnosis? What assessments and tests would you perform and why?
Student Response:
Model Note: Differential diagnosis includes viral pharyngitis, strep throat, influenza, cold, and sinusitis. To rule out strep, a rapid strep is indicated. Palpation of the cervical lymph nodes may demonstrate enlarged, tender, cervical lymph nodes. Visualization of the throat also gives clues to the diagnosis. White pus pockets and petechiae on the palate are classic signs of strep throat. Erythema alone may indicate viral infection or postnasal drip. If purulent discharge is noted in the posterior pharynx assess for nasal discharge and palpate the appropriate sinuses for the patient’s age. If palpation elicits pain and purulent nasal discharge is reported over the last 7-10 days, consider sinusitis. A negative rapid flu test would rule out influenza.
Tina’s 76-year-old great aunt comes into the clinic for a visit and you find that she frequently asks you to repeat what you say. During the Rinne test, you find that air conduction is greater than bone conduction in her left ear. What is your differential diagnosis? What additional assessments would you perform?
Student Response: Model Note: Differential diagnosis includes sensorineural hearing loss and anatomical defects. Sensorineural hearing loss is common in old age and can be caused by heredity, diabetes, cerebrovascular disease, excessive noise, ototoxic medications, hyperlipidemia, hypothyroidism, and renal failure. Assessments should include a history of hearing impairment and ear injuries. It is important to inquire about chronic ear infection or other trauma that leads to anatomical abnormalities. An analysis of Tina’s great aunt’s medications and past medications can be used to rule out ototoxicity. Fasting glucose levels and Hgb A1C can be tested to rule out diabetes. TSH and T4 levels can rule out hypothyroidism. GFR or creatinine levels can rule out renal failure. Triglycerides, cholesterol, HDL, and LDL levels can be used to rule out hyperlipidemia. A neurological assessment should be completed to rule out cerebral ischemia. If no concrete diagnosis is made, the hearing loss should be attributed to old age.
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