Differential Diagnosis. Case Study Vignette

Case Study

A 78-year-old female comes to your office escorted by a neighbor who is a patient of yours. The
neighbor, who has lived next door to the older woman for years, relates that a week ago the
elderly woman’s sister died and that she had been her caregiver for many years. The neighbor relates that although she would occasionally see the older woman, she did not visit the home. At the funeral last week, she noticed that the woman appeared fatigued, confused, sad, and gaunt in appearance. Later the neighbor approached the woman, inquired about her health, and
determined that the woman had a very difficult time the past couple of months, caring alone for
her sister until the end when hospice care was initiated. The neighbor convinced the woman to
seek medical care and today is the first appointment with a provider that this 78-year-old female
has had in 3 years. The older woman states that she is very fatigued and sad over the loss of her
sister. Neither her sister nor the patient has been married. A distant niece came to the funeral but
lives about 30 miles away. The woman states that she is not taking any prescription medication
and relates no medical problems that she is aware of being diagnosed.
Vital signs: T 97.6°F, HR 98, RR 22, BP 95/60, BMI 21
Chief Complaint: Fatigue and sadness over the death of her older sister.
Discuss the following:
1) What additional subjective information will you be asking the patient?
2) What additional objective findings would you be examining the patient for?
3) What are the differential diagnoses that you are considering?
4) What laboratory tests will help you rule out some of the differential diagnoses?
5) What screening tools will you select to use on this patient?
6) What is your plan of care?
7) What additional patient teaching may be needed?
8) Will you be looking for a consult?

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