Chief Complaint:
History of Present Illness
A 52 y.o. female presents with the chief complaint that her tongue is red x 2 weeks. Her dental hygienist mentioned it to her at a recent apt and told her to get it “checked out.” States she has noticed a change in taste when she eats spicy foods. She reports that she noticed the change in taste when she started using a new brand of toothpaste one month ago.
Past Medical History/Current Meds
Self-diagnosed acid reflux treated with OTC omeprazole PRN
Hiatal hernia surgery 3 years prior
Post-menopausal
Family History
Hypertension
Psychosocial History
Drinks 2-3 glasses of wine per week. Denies tobacco use or drug use.
Review of Symptoms
As noted per HPI only, not completed
Physical Examination
Vital signs: HR 103, BP 128/71, HT 68 inches, WT 130 lbs.
General: Well appearing
EENT: eyes anicteric, PERRL, TM’s pearly gray, mucous membranes are moist. Tongue is slightly enlarged, smooth with a reddish appearance. Mildy tender to palpation. 1.5 cm fissure present. No ulcerations present.
Neck: Supple, no lymphadenopathy noted
CV: S1/S2 present, regular rhythm. No murmurs, clicks or rubs.
Respiratory: Clear to auscultation bilaterally
MSK: FROM, strength 2+, coordinated. No lesions, deformities.
Case Study Discussion – Part I:
Identify a minimum of three conditions that you would consider in your differential diagnosis, with the most likely condition listed first. Provide rationale for each differential with supporting evidence from the case study.
What further history, further examination, and diagnostic studies should be considered in order to explore your differential diagnosis and confirm your suspicions?
Three differential diagnosis in the condition are :-
1- Allergic reaction to the new toothpaste as the tongue is reddish ,and slightly enlarged
2- Fissured tongue - as her tongue has 1.5 cm fissure and mildly tender
3. Tongue cancer - tongue appears to be reddish and inflamedand there is change in taste , might be the initial signs of malignancy.
Diagnostic test to confirm diagnosis - a sample of tongue tissue for histopathology and cytology to detect cancer , blood investigation including ESR ,ANC to see whether it's due to allergic reaction, biopsy to see the tissue for cancer .
Chief Complaint: History of Present Illness A 52 y.o. female presents with the chief complaint that...
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