Differential Diagnosis - N&V in Teen

04/29/24 • 11 min

Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 4 h ago, last stool was around 2 h ago, reported as yellow brown in color, small volume and without blood. He has been tolerating a sips of clear liquids for the past 3 h and voided a small amount around 2 h ago. Joesph reports that he is on the wresting team at his high school and that, “For the past week, one guy after another got this same thing.” VS are within normal limits and his mucous membranes are slightly dry. The most likely cause of Joseph’s clinical condition is:
A. Staphylococcal food poisoning
B. Clostridium difficile (C. diff) enteritis
C. Viral gastroenteritis
D. Gastric ulcer
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YouTube: https://www.youtube.com/watch?v=_n_b1BfwfUc&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=66

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Previous Episode

Food Poisoning

Sonia is a 15 year old teen who plays varsity basketball and is generally well and up-to-date with health maintenance. She presents for an urgent care visit with a 6-h history of sudden onset nausea, with multiple episodes of vomiting, abdominal cramping and 2 episodes of diarrhea with stool described as light to dark brown without visible blood. Her VS are within normal limits and mucous membranes are slightly dry. She has slightly hyperactive bowel sounds and mild exceptional tenderness without rebound. When considering a diagnosis of staphylococcal food poisoning, which would most likely be reported by Sonia?
A. "One after another, the people on my basketball team have been getting sick like this during the past week."
B. "My basketball team stopped at a restaurant today to get something to eat on our way home from a game. Practically all of us who got turkey sandwiches are sick like this.”
C. "I had an ear infection a couple of weeks ago, and I took about 5 days of an antibiotic."
D. "I have really bad cramps during my period, and I take a lot of ibuprofen to help out."
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YouTube: https://www.youtube.com/watch?v=_UylkKk9VkY&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=66

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Next Episode

Viral gastroenteritis

Joseph is a 14 year-old, generally well and up-to-date with health maintenance, who presents for a sick visit, stating, “My stomach has not been right for about 4 days. The illness began with a 36 h hx of gradual onset nausea, vomiting and loose stools, reporting “I’m not sure how many times I threw up or had diarrhea.” He last vomited about 24 h ago, last stool was around 4 h ago, reported as yellow-brown in color, small volume and without blood. He has been tolerating clear liquids for the past 24 h and voided a small amount around 2 h ago. He feels “a little bit hungry but I am afraid to eat or I might throw up again. I still feel a little bit sick to my stomach.” Joesph reports that he is on the wresting team at his high school and that, “For the past week, one guy after another got this same thing.” VS are within normal limits and denies dizziness with position change from supine to sit or stand. His mucous membranes are slightly dry, with intact skin turgor, and mild diffuse abdominal tenderness without rebound. With a working diagnosis of viral gastroenteritis, which of the two following clinical actions should be taken?
A. Obtain stool for culture and sensitivity.
B. Order a chem panel.
C. Provide information about a slowly progressive diet as tolerated.
D. Prescribe an antiemetic.
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YouTube: https://www.youtube.com/watch?v=_P1Ff1fWzJI&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=67

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NP Certification Q&A - Differential Diagnosis - N&V in Teen

Transcript

Voiceover: Welcome to NP Certification Q&A presented by Fitzgerald Health Education Associates. This podcast is for NP students studying to pass their NP certification exam. Getting to the correct test answers means breaking down the exam questions themselves. Leading NP expert Dr. Margaret Fitzgerald shares her knowledge and experience to help you dissect the anatomy of a test question, so you can better understand how to arrive at the correct test answer.

So if you're ready, let's