How To Differentially Diagnose Like House MD

How to differentially diagnose like House MD

To differentially diagnose like House MD you have to practice and study hard. This is a practice case which is aimed at helping you hone your differential diagnosis skills. The following cases are meant to function as practice cases for students within medicine, neurology, chiropractic, osteopathy or similar healthcare professions which are involved in diagnosing medical and neurological pathology.

Be forewarned that the answers to the case is listed at the bottom of this article. Good luck!

1.

• In a patient with burning pain, tingling and numbness over the entire plantar aspect of the right foot, that is worse at night, which of the following is the most likely diagnosis?

1. Peripheral vascular disease
2. Sinus tarsi syndrome
3. Distal tarsal tunnel syndrome
4. Plantar fascitis
5. Peripheral neuropathy of the sural nerve

2.

• A football player presents with foot drop after being kicked in the leg. He cannot dorsiflex or evert his foot. Sensation is lost over the front and outer half of the leg and dorsum of the foot. What is the most probable diagnosis?

1. Sural nerve injury
2. Tibial nerve injury
3. Superficial peroneal (or fibular) nerve injury
4. S1 nerve root injury
5. Common peroneal nerve injury

3.

Theme: Chronic “joint” pain

• A 72-year-old female complains of arthritis in the fingers and big toe. On examination there are bony swellings of the proximal interphalangeal joints and metatarsophalengeal joints. There is no redness, heat or soft tissue swelling in the involved joints. The most likely diagnosis is:

Options:

1. Gout
2. Septic arthritis
3. Rheumatoid arthritis
4. Osteoarthritis
5. SLE
6. PMR
7. Multiple myeloma
8. AS
9. Paget’s disease

4.

Using the same options above:

• A 60-year-old man complains of low back and hip pains. Systems review reveals that he is also hard of hearing. X-rays shows a coarsening of architecture in the 2nd to 4th lumbar vertebrae. The vertebra bodes appear enlarged with a prominent cortical margin. The most likely diagnosis is ...? (see answer options above)

5.

Using the same options above:

A 25-year-old man presents with a 12 month history of low back pain and stiffness which is worst first thing in the morning. The stiffness eases somewhat with activity but the pain persists. The pain extends into both buttocks and upper posterior thighs. The back pain can wake him at night. On examination the SIJs are tender on compression and Schober’s test shows an increase of 3cm on forward flexion. X-rays reveal indistinct and slightly widened SIJs. The most likely diagnosis is...? (see answer options above)

6.

• Which form of arthritis is more common in males?

1. Polyarticular Juvenile Rheumatoid Arthritis (JRA)
2. Systemic JRA
3. Seronegative spondyloarthropathy
4. Rheumatoid arthritis (adult)
5. Osteoarthritis

7.

• What percentage of patients with ankylosing spondylitis have the HLA-B27 antigen?

1. <60%
2. 60-70%
3. 70-80%
4. 80-90%
5. >90%

8.

• Which muscle shows the most activity during a rear-end collision?

1. Middle trapezius
2. SCM
3. Anterior scalenes
4. Suboccipitals
5. Levator scapulae

9.

Theme: Whiplash

•The following can be said following a rear-end collision:

1. The occupants head stays stationary initially due to inertia
2. After the head starts to move the neck forms an “S” shaped curve
3. The flexion phase is recognised as the primary source of injury

Options:

A None of the answers are true

B Answer i) only is true

C Answer ii) only is true

D Answer iii) only is true

E Answers i) and ii) only are true

F Answers i) and iii) only are true

G Answers ii) and iii) only are true

H All of the answers are true

10.

•The following factors increase the likely severity of neck injury in a rear end collision:

1. Large mass target vehicle
2. Neck rotation at the time of impact
3. Female gender

11.

A 69-year old woman presents with WAD 4 weeks after a rear-end collision. She is complaining of neck pain, arm pain and headaches.

If you were thinking:She is at risk of prolonged disability

And then you find:She is a smoker and has had osteoarthritis in the cervical spine for 10 years

This hypothesis becomes: -2 (very unlikely) -1 (less likely) 0 (no difference)+1 (more likely)+2 (almost certain)

12.

Theme: Controlling inflammation

Statements:The following nutritional advice may help control inflammation:

1. Take Bromelain supplements
2. Take fish oils
3. Reduce intake of meat and dairy products

Options:

A None of the answers are true

B Answer i) only is true

C Answer ii) only is true

D Answer iii) only is true

E Answers i) and ii) only are true

F Answers i) and iii) only are true

G Answers ii) and iii) only are true

H All of the answers are true

13.

A 32-year old woman presents complaining of neck and right arm pain following a road traffic collision. She was the driver of a small car that was stationary when it was hit from behind by a Transit van. She denies any neck or arm pain prior to the accident. Examination findings include, reproduction of neck and arm pain on Spurlings, weakness in the wrist flexors and finger extensors and a 1+ triceps reflex on the right.

Based on this information how should you grade her WAD?

A Grade 0

B Grade I

C Grade II

D Grade III

E Grade IV

14.

A 32-year old woman presents complaining of neck and right arm pain following a road traffic collision. She was the driver of a small car that was stationary when it was hit from behind by a Transit van. She denies any neck or arm pain prior to the accident. Examination findings include, reproduction of neck and arm pain on Spurlings, weakness in the wrist flexors and finger extensors and a 1+ triceps reflex on the right.

What would be the most likely working diagnosis?

A C6 radiculopathy

B C6 radicular pain syndrome

C C7 radiculopathy

D C7 radicular pain syndrome

E Peripheral entrapment neuropathy of the radial nerve

15.

16.

Theme: Cervicogenic headache

Statement: The following can be said of cervicogenic headache:

1. The pain is typically non-throbbing pain of moderate intensity
2. It can be caused by myofascial trigger points
3. It is typically bilateral

Options:

A None of the answers are true

B Answer i) only is true

C Answer ii) only is true

D Answer iii) only is true

E Answers i) and ii) only are true

F Answers i) and iii) only are true

G Answers ii) and iii) only are true

H All of the answers are true

17.

Theme: Headache

Case: A 42-year-old woman complains of severe headaches which occur about once a month. The headaches are right sided and she describes them as throbbing in nature. The pain gradually builds up over about an hour and usually lasts the rest of the day. The headaches are often accompanied by nausea and photophobia.

Examination findings include anterior head carriage and trigger points in the right upper trapezius muscle which were locally tender but did not refer pain.

The most likely diagnosis is (see options below):

Options:

1. Paroxysmal hemicrania
2. Cluster headache
3. Malignant hypertension
4. Migraine
5. Raised intracranial pressure
6. Tension headache
7. Cervicogenic headache
8. Temporal arteritis
9. Subarachnoid haemorrhage
10. Glaucoma
11. Meningitis

18.

Using the options above:

Case: A 29-year-old woman presents complaining of a severe occipital headache of 6 hours duration. She says she has had headaches in the past but none like this. The onset of the headache was sudden, the patient describes it as if a brick had fallen onto her head. She also feels nauseous and prefers to sit quietly in the dark. Vital signs are within normal limits.

The most likely diagnosis is …? (see answer options above):

19.

Using the options above:

Case: A 25-year-old woman complains of a headaches which feel like pressure on the top and a tight band around her head. They last for days to weeks and are sometimes worse in the mornings. She denies any other associated symptoms. OTC painkillers provide little relief.

There are no abnormalities on stance, gait, cranial nerve or SMR examination. Blood pressure is 145/90 bilaterally. Temperature is 37.8°C.

The most likely diagnosis is…? (see answer options above):

20.

Theme: Facial pain

lStatements: The following causes of facial pain have an increased incidence in the elderly:

1. Trigeminal neuralgia
2. Herpes zoster
3. Glaucoma

Answer options:

1. A None of the answers are true
2. B Answer i) only is true
3. C Answer ii) only is true
4. D Answer iii) only is true
5. E Answers i) and ii) only are true
6. F Answers i) and iii) only are true
7. G Answers ii) and iii) only are true
8. H All of the answers are true

--- WARNING: List of answers follows ---

ANSWERS:

1. C
2. E
3. D
4. I
5. H
6. C
7. E
8. B
9. B
10. G
11. +1
12. H
13. D
14. C
15. D
16. B
17. D
18. I
19. F
20. H

Feel free to print these questions and share the article with your fellow colleagues / students. Best of luck onwards, be sure to check out my other practice cases as well.