Differential Diagnosis Exercise
CC – “I have drainage from my eye”
HPI – 26 year old female complains of drainage from her right eye that started 3 days ago and has gotten worse. She describes the drainage as white and stringy. She notices the drainage all day long and is quite bothersome to her. She has tried Visine but it has not made it any better. Nothing specific seems to make it worse. She denies any fever, eye pain, or feeling like there is anything in the eye. Denies any difficulty with her vision. The amount of drainage is significant utilizing one Kleenex an hour to absorb it.
Based on the Case Study – generate 5-7 potential diagnosis based on the patient complaints.
- Risk for injuring
- Risk for infection spread –
- Disturbed body image related to eye drainage
- Anxiety related to unknown cause of eye drainage
- Fear of unknown
For Question 1, you should have outlined the following potential diagnosis:
- Bacterial conjunctivitis
- Viral Conjunctivitis
- Allergic Conjunctivitis
- Keratitis (inflamed Cornea)
- Blocked Tear Duct
- Foreign Object in the Eye
- Scratched Cornea
- Glaucoma
Now that you have a list of potential diagnosis utilize your knowledge of each condition to identify common symptoms / characteristics to narrow down the list.
| Potential Diagnosis | Characteristics |
| Bacterial conjunctivitis | Thick yellow or green drainage. Eye lid can be stuck in the morning with crusty colored drainage |
| Viral Conjunctivitis | Drainage is watery, mucous like, eye lid can be stuck in the morning with clear drainage |
| Allergic Conjunctivitis | White or pale yellow stringy drainage, consistent |
| Keratitis (inflamed Cornea) | Red eye, difficulty with vision, eye pain, sensitive to light |
| Foreign Object in the Eye | Complaints of something in the eye – clear drainage |
| Scratched Cornea | Clear drainage (tear like), pain in the eye |
| Glaucoma | Watery eyes, decreased vision, eye pain |
Based on the case study and table above, what is the working diagnosis?
Allergic Conjunctivitis ; White or pale yellow stringy drainage, consistent
For Question 2, you should have determined the working diagnosis is allergic conjunctivitis. Now, let’s move on to Student Case #1:
CC: “I have a cough”
HPI – 36-year-old female complains of a cough. The cough started about 3 weeks ago and occurs nightly, it is non-productive and dry and occurs mostly at bedtime. She feels fine and then goes to bed and starts coughing. She gets up for a drink and it gets better but then gets worse when she lays down again. She has not tried any medications or treatments. Nothing seems to make it better or worse. She denies any wheezing, congestion, nasal stuffiness, or aching.
Generate a list of 5-7 potential diagnosis.
Gastroesophageal Reflux Disease
Asthma
Hay Fever
COPD
Pneumonia
Pertussis
Add characteristics for each of the potential diagnoses, outlined in question 3.
| Potential Diagnosis | Characteristics |
Asthma : Wheezing, coughing especially at night
GERD: Non productive dry cough, coughing after eating or lying down.
Hay Fever : Watery eye, sniffing, chronic non productive cough
fatigue.
Pertussis: Running nose, Mild to severe coughing
Pneumonia : fatigue, cough, SOB sweating.
Here are some potential diagnosis and characteristics to compare to your answers:
| Diagnosis | Characteristics |
| Bronchitis | Symptoms throughout the day, wheezing, chest tightness |
| Asthma | Coughing, wheezing, chest tightness, Consistent symptoms day / night |
| Pneumonia | Productive cough, fever, wheezing, symptoms day / night |
| Cold (virus) | Nasal congestion, achy, consistent symptoms through the day / night |
| Allergies | Sneezing, runny nose, wheezing, itchy eyes Consistent symptoms through the day / night |
| Gastroesophageal reflux disease (GERD) | Cough starts when laying flat, no wheezing, nigh time symptoms (positional) non productive |
The mostly likely working diagnosis would be GERD.
How did you do?
Very well
CC: “I have pain in my abdomen”
HPI – 56-year-old male complains of pain in his abdomen that started about a month ago. He states the pain comes and goes and is usually worse after meals. He points to his right upper abdomen for the location of the pain. He has some nausea but no vomiting. He describes the pain as severe, sharp, and crampy after eating and radiates into the shoulder and back. He denies any bloating or diarrhea. His stools have been a clay like color recently. He denies any fever or chills. Eating bland food seems to make the pain better. He has tried antacids and omeprazole without much effect. The worse pain was rated a 9 after a meal of cheeseburger and fries.
Generate a list of 5-7 potential diagnosis related to this case.
Acute cholecystitis
Gallstones
Appendicitis
Bowel obstruction,
Diverticular disease
Liver or Pancreases issues
Gastritis
Add characteristics for each of the potential diagnosis:
| Potential Diagnosis | Characteristics |
Diverticular disease: Pain in the upper stomach. White or pale stool
Appendicitis: A dull ache around the belly bottom that can radiate to the upper stomach
Gallstones: Intense pain in the upper right stomach, fatigue, vomiting
Liver or Pancreases issues: Untreated block biliary duct causing pain in the liver, inflammation
Bowel Obstruction : Constipation, difficult digesting and absorbing food , intense pain
Gastritis: Swollen stomach lining and pain, allergies, NSAID
Compare your answers to these:
| Potential Diagnosis | Characteristics |
| Pancreatitis | Pain worsens after eating, pain radiates to back / chest, swelling / tenderness of abdomen, diarrhea, fluid build up in the abdomen, no change in the color of the stool |
| Appendicitis | Pain usually starts periumbicular and then moves to right lower quadrant, fever is late sign, nausea / vomiting, pain usually not related to meals, increase pain with cough or ambulation |
| Peptic Ulcer Disease | Dull pain or burning in upper abdomen, nausea / vomiting, bloating, belching, heartburn, pain worsens after eating, black or bloody stools |
| Cholecystitis | Pain worsens after eating, pain radiates to back / chest, color change in stools, nausea / vomiting, bloating |
| Kidney Infection | Pain is located more in the CVA, pain not related to meals, usually fever associated, not as common in men |
| Hepatitis | Pain or bloating in the belly, nausea/vomiting, fatigue, jaundice, dark urine, pale stools, diarrhea, |
The working Diagnosis: Cholecystitis
How did you do?
Fair
