A 17-year-old African American from the inner city complains of severe chest and abdominal pain. Upon examination the attending physician performs and EKG, chest x-ray, and an abdominal and chest clinical examination and finds nothing.

One 17-year-old African American in the inner city is complaining of chest and abdominal pain. The attending physician performed an EKG and chest x-ray as well as an abdominal and chest clinic examination. He found nothing. Assuming that she was drug seeking, he sent her home. Four hours later she returns to the ER, where you now see her. She tells you that, despite the heat (100 F), she ran track at her school yesterday afternoon. Her chest and stomach begin to hurt. The woman has jaundiced skin, a blood pressure of 98/50 and a pulse of 112, while her T is 99.9 F. R is 28. It seems that the pain is out of proportion with her physical condition.

1.1 Differential diagnoses:

• It is possible that the patient has a Sickle Cell Crisis, especially if he is African American with severe abdominal and chest pain. A fever, rapid pulse rate and shortness in breath are common symptoms of a Sickle Cell Crisis. Jaundiced or yellow eyes are also indicative of this diagnosis.
• Acute Pancreatitis: This condition is marked by abdominal pain. Jaundice can also occur due to obstruction of bile ducts caused by an inflamed liver. In this condition, elevated levels of lipase or amylase are common.
• Heat stroke: This condition occurs when a patient is running on track in sweltering heat. It’s characterized by a high fever, accelerated heartbeat, and low blood-pressure. Jaundice and abdominal pain are rarer but can occur.

In this situation, the most probable diagnosis is sickle cell crises. This is based on the patient’s symptoms, which include severe pain in the abdomen and chest, fever, and jaundiced eyes. The patient’s race is also a risk factor for sickle cell disease.

1.3 A change in the differential diagnosis is required if the patient displays stroke-like signs and symptoms. The differential diagnosis will need to be extended to include strokes or transient attacks of ischemic stroke.

Treatment: To manage sickle-cell crisis, the patient will be given pain medicine and fluids. The patient may require thrombolytics if they exhibit stroke-like signs. It is important to provide adequate pain control, maintain hydration, and monitor the patient’s vital signs.

1. Preventative measures: By providing more information to the sickle cell patient about their illness, it may have been possible for this crisis to be avoided. The prevention of future crises may be achieved by teaching patients the importance of staying hydrated and to avoid any triggers like extreme physical activity in hot weather.

Jesse has 57 and is experiencing dyspnea with fatigue. He has frequent dyspepsia, GERD with nausea. At night he complains of difficulty breathing (Orthopnea), especially when lying backward. Sitting up helps him to relieve this. He has vitals of 180/110. P = 88. T = 98.0F. R = 20.

2.1 Differential diagnoses:

• Congestive heart failure (CHF): This is the most likely diagnosis, given the patient’s dyspnea on exertion, orthopnea, and elevated blood pressure.
• COPD: COPD may cause fatigue and dyspnea when exerted. The orthopnea, however, is much less common.
• Pulmonary embolism: This could be a possibility, given the patient’s dyspnea on exertion, but the orth.