Question

What three medical diagnosis would you give Allen?

Allen is a 62-year old white male. He comes in today with his wife with complaints of a vague sense of fatigue for the past year and not being able to do his routine work around the house with as much energy and efficiency as he used to have. He was recently forced to take early retirement after working for an accounting firm for the past 30 years. He states that this recent change in employment has him feeling “down”. Although he had planned to retire within the next 5 years, this unplanned early retirement has been serious financial setback for the couple. He continues to seek various part-time jobs to supplement his wife’s salary. His wife and he relate an incident last week at their house. The patient had attempted to light a stove burner that had a faulty ignition. He failed to smell the accumulating gas fumes. His wife, who was in an adjoining room, smelled the gas odor and ran into the kitchen to check the stove. The patient was surprised that his wife smelled the gas when he did not. The patient’s wife also mentioned that she has noticed over the past 3 months an occasional slight tremor in Allen’s right hand that seems less noticeable when he reaches for his coffee cup; the patient however, attributes this to too much caffeine and has recently tried to cut back his usual 4-6 cups of coffee per day. Upon further questioning about his movement, he notes that he experiences initial stiffness in his right knee upon starting to walk, but that this sensation goes away after walking the length of 2 city blocks. This has been present for the past 6 months, but it does not bother or concern him. The patient denies recent falls, serious illnesses, or recent nasal/sinus infections or surgery. He has worn glasses for reading for 8 years and has never had to wear glasses for distance until his last eye exam 3 months ago. When questioned about changes in behavior, the patient said he didn’t think he had any, but his wife was of a different opinion. She mentioned that for the past year he has seemed less efficient than usual in his actions, easily losing focus on what he is doing and unable to prioritize things he needs to do for the day. Allan denies any chest pain, shortness of breath, joint pain, or muscle aches, fever, nausea, vomiting, diarrhea, trouble urinating, blood in urine, headaches, or back pain. He admits to recent problems with constipation for the last month.

Past medical and surgical history: Negative for diabetes, cancer, hypertension, HLD, respiratory disease, and neurological problems. Surgeries include tonsillectomy at age 9.

Family history: Father died of prostate cancer at age 73. Mother died of Alzheimer’s related complications at age 72. Brother (age 70) is alive and doing well following treatment 2 years ago for lung cancer. Sister (age 67) is alive and well.

Social History: Married to his high school sweetheart for 40 years. Works part-time out of his home as a math teacher for local high school and college students. His wife works full time as a teacher. He has two children, both in graduate school and living away from home. He and his wife enjoy a glass of wine with dinner about 2-3 times per week; he has a beer at the local pub once every weekend during football season. He quit smoking 20 years ago (a 1 pack per day habit). He states he enjoys playing bridge and joined a neighborhood bridge group 2 months ago as a social outlet. He does not notice any tremor in his right hand when he plays, but he says he cannot shuffle the cards as well as he used to.

Medications: Daily multivitamin, as needed ibuprofen for occasional elbow pain related to increased activity (golf). Allergies: No know allergies. Vitals: Height 69 inches, Weight 170 lbs, BP 130/70, HR 72 and regular, Temp. 97.6 F.

Answer 1

Answer:

In my opinion the three diagnosis are:

1.Chronic fatigue syndrome

Reason: It is disorder characterized by extreme fatigue and can't be explained the underlying cause. Patient has fatigue and unable to do routine work for past years.

2.Parkinson's disease

Reason: He is having tremor in one hand especially in right hand is a symptom of Parkinson's and it starts with barely noticable tremors. Muscle stiffness can occur at any part of the body.Loss of sensation of smell is also another feature of this disease.

3.Adult ADHD

Reason: It is characterized by loss of concentration and unable to focus and prioritize the  things.The patient takes analgesics for pain caused by increased activity.