Please answer this following question using the VINDICATE guideline that are provided as well as the discussion rubric below. please feel free to contact me.
A 44-year-old woman presents to her local emergency department after 5 days of persistent fever, productive cough, and worsening dyspnea on exertion. She states that her phlegm is green but denies any blood or dyspnea at rest. She has no other complaints and denies any recent travel or drug abuse. Vital signs are normal except for a pulse oxygen of 92% on room air. Blood pressure was fine at 144/73 mm Hg and remained in that range on repeat exam. Her physical exam was normal except for diffuse rales and wheezing and the skin changes noted below. There was no edema, and her skin temperature was normal.
What is your diagnosis and differentials. Use VINDICATE
What is your plan of treatment? Explain.
What is the mechanism of action for these medications?
Here is the VINDICATE guidelines
Terminology used in this course:
As you work through to diagnoses: If patient has a neurological symptom or other follow a systematic approach
As with reading a chest X-ray or EKG, the key to generating a strong differential diagnosis is to follow a systematic approach. Think about all options.
The mnemonic “VINDICATE” offers one such system to generate a broad and thorough differential in diagnosis:
V – Vascular I – Infectious N – Neoplastic D – Degenerative I – Iatrogenic/intoxication C – Congenital A – Autoimmune T – Traumatic E – Endocrine/metabolic
Vascular – stroke, TIA, subarachnoid hemorrhage
Infectious – meningitis, encephalitis, sepsis
Neoplastic – primary brain tumor or metastasis
Degenerative – Alzheimer’s disease, Huntington’s disease, other dementias
Iatrogenic/intoxication – narcotics, drug therapy, alcohol intoxication or withdrawal
Congenital – epilepsy (post-ictal state)
Autoimmune – lupus, RA, sarcoid, neurosarcoidosis if you want to get fancy!
Traumatic – traumatic brain injury, traumatic epidural or subdural hematoma
Endocrine/metabolic – hypoglycemia, hypo- or hyperthyroidism, hypo- or hypernatremia, hypercalcemia, hepatic or uremic encephalopathy