I
NURI6104IIHUMANICASEISTUDY
DOROTHYIMARKHAM,I78IYRS.IFEM
ALEICC:
“DIARRHEA”I2IDIFFERENTIVERSION
SIOFITHEIANSWER
CONTENTS:IQUESTIONS,IOLD-CARTSIforItheIHPI,I(PMH,IFH,ISHIasI
Needed),IPHSICALI
EXAM,IEXAMSIFEEDBACK,ICASEIFINDINGS,IFEEDBACK,IDIFFERENTIALIRA
NKING,I
DIAGNOSIS,ICASEIPLAN,IListItheIdifferentialIdiagnosesI(MustInotIMiss/L
eading/Alternate/Concluding)I
I
I
I
I
VERSIONIAI
I
DorothyIMarkhamI
I
PatientIisI78IyouIfemaleIwhoIcurrentlyIresidesIinIaInursingIhome.IRec
entlyItreatedIwithIantibioticsIforIUTI.IHistoryIofIGERD,IHTN,Iosteopo
rosis,IsheIisIaIformerIsmoker:I20Ipack-
yearIhistoryIwhoIadmitsItoIhaveI1IdrinkIperIweek.IMs.IMarkhamIpres
entsItoIEDIwithIacute,Inon-
Ibloody,Idiarrhea,Ibloating,InauseaIandIdiffuseIabdominalIpainIofI2Iday
sIinIduration.ISheIhadImultipleIbowelImovementsIonItheIfirstIdayIandI
, sheIreportsIcramps,IwhichIcomeIandIgo,IpainIlevelI6/10IandIrestImake
sIitIbetter.ISheIdeniesIbloodIinIstool,IorIfecalIincontinenceIhasIlittleIap
petiteIcausedIbyInausea.ISheIdeniesIsickIoutbreakIatIrehabIfacilityIorIr
ecentItravels.ISheIhasInotIbeenIableItoIassociateIherIsymptomsIwithIdi
etaryItriggers.INotIsureIaboutIfeversIbutIstatesIthatIsheIfeltIwarmIforIla
stIcoupleIdays,IcomplainsIofIdizzinessIandIbeingIlightheaded.ISheIhasI
clinicalIsignsIofIorthostaticIhypotensionIwithIvolumeIdepletionIdueItoI
herIinabilityItoImaintainIadequateIoralIhydrationIandIherIongoingIuseIo
fIdiuretics.ISkinItentingIisIpresentIonItheIbackIofItheIhand,IcapillaryIre
fillIisIgreaterIthanI2Iseconds.IPatientIMMSEI28/30.IWBCI18,000Iwith
outIleftIshift,IelevatedIlactateI2.5Immol/L,IelevatedIBUNIandIcreatinin
eIratioI>I20:1,IconcentratedIurineIandIpositiveIclostridialItoxinIassayIin
dicatingIC.IdiffIorganism.IBothIparentsIdeceased,IfatherIdiedIofIheartIa
ttackIatI60Iyou,IchildrenIareIok,IHTNIrunsIinIherIfamilyIandIbothIherI
andIherIbrother.I
NURI6104IIHUMANICASEISTUDY
DOROTHYIMARKHAM,I78IYRS.IFEM
ALEICC:
“DIARRHEA”I2IDIFFERENTIVERSION
SIOFITHEIANSWER
CONTENTS:IQUESTIONS,IOLD-CARTSIforItheIHPI,I(PMH,IFH,ISHIasI
Needed),IPHSICALI
EXAM,IEXAMSIFEEDBACK,ICASEIFINDINGS,IFEEDBACK,IDIFFERENTIALIRA
NKING,I
DIAGNOSIS,ICASEIPLAN,IListItheIdifferentialIdiagnosesI(MustInotIMiss/L
eading/Alternate/Concluding)I
I
I
I
I
VERSIONIAI
I
DorothyIMarkhamI
I
PatientIisI78IyouIfemaleIwhoIcurrentlyIresidesIinIaInursingIhome.IRec
entlyItreatedIwithIantibioticsIforIUTI.IHistoryIofIGERD,IHTN,Iosteopo
rosis,IsheIisIaIformerIsmoker:I20Ipack-
yearIhistoryIwhoIadmitsItoIhaveI1IdrinkIperIweek.IMs.IMarkhamIpres
entsItoIEDIwithIacute,Inon-
Ibloody,Idiarrhea,Ibloating,InauseaIandIdiffuseIabdominalIpainIofI2Iday
sIinIduration.ISheIhadImultipleIbowelImovementsIonItheIfirstIdayIandI
, sheIreportsIcramps,IwhichIcomeIandIgo,IpainIlevelI6/10IandIrestImake
sIitIbetter.ISheIdeniesIbloodIinIstool,IorIfecalIincontinenceIhasIlittleIap
petiteIcausedIbyInausea.ISheIdeniesIsickIoutbreakIatIrehabIfacilityIorIr
ecentItravels.ISheIhasInotIbeenIableItoIassociateIherIsymptomsIwithIdi
etaryItriggers.INotIsureIaboutIfeversIbutIstatesIthatIsheIfeltIwarmIforIla
stIcoupleIdays,IcomplainsIofIdizzinessIandIbeingIlightheaded.ISheIhasI
clinicalIsignsIofIorthostaticIhypotensionIwithIvolumeIdepletionIdueItoI
herIinabilityItoImaintainIadequateIoralIhydrationIandIherIongoingIuseIo
fIdiuretics.ISkinItentingIisIpresentIonItheIbackIofItheIhand,IcapillaryIre
fillIisIgreaterIthanI2Iseconds.IPatientIMMSEI28/30.IWBCI18,000Iwith
outIleftIshift,IelevatedIlactateI2.5Immol/L,IelevatedIBUNIandIcreatinin
eIratioI>I20:1,IconcentratedIurineIandIpositiveIclostridialItoxinIassayIin
dicatingIC.IdiffIorganism.IBothIparentsIdeceased,IfatherIdiedIofIheartIa
ttackIatI60Iyou,IchildrenIareIok,IHTNIrunsIinIherIfamilyIandIbothIherI
andIherIbrother.I
