A 23 year old female presents with lack of energy and weight gain 1.

What different organ systems can be related to this constellation of symptoms? List the different possible diagnoses by organ system.

Digestive system: 1. 2. 3. 4. 5. 6. 7. Celiac Sprue disease Inflammatory Bowel disease Crohns Small Bowel Disorder Food Allergy Diabetes Essential fatty acid deficiency

Endocrine system: 1. 2. 3. 4. Hypothyroidism Cushing's Syndrome Adrenal gland disorders Exogenous steroid or hormone usage

Nervous system: Depression Insomnia Stress Excretory system: Kidney failure Reproductive system: Pregnancy 2. Given the age and gender of this patient, please pick your top five most likely diagnoses. Pregnancy, Hypothyroidism, Cushing's Syndrome, depression, kidney failure (not as likely as the others given the age) a. What questions about the symptoms can help you differentiate between each diagnosis?

Are you eating more than usual? Are you sleeping more often than normal? (Symptomatic of hypothyroidism and depression) Have you had any severe hair loss recently? (symptomatic of hypothyroidism) Do you have shortness of breath (symptomatic of kidney failure)? Swelling in legs (kidney failure)? Coarseness of hair or dryness of skin? Is your menstrual cycle regular? Have you missed it recently? (Irregularity or cessation both for Cushing's or pregnancy) How many sexual partners have you had in the last month? How many are men? What was the method of sex? (If yes), Did you have sex unprotected? (pregnancy) Is your skin bruising or healing slowly (Cushings Syndrome)? Are you having excessive hair growth? Do you have any stretch marks appearing on your body (symptomatic of Cushings Syndrome)? Have you been suffering from nausea? Do your muscles cramp (hypothyroidism)? Have you suffered from diarrhea? Have you been having constipation (hypothyroidism)? Has your stool been bloody? (Depressions can also be a symptom of Cushing's). Do you smoke? Have you been using drugs? How much do you regularly drink? (can be depression if excessive drinking) Do you feel depressed? b. What questions about the patients past medical history would be important to ask to help differentiate each diagnosis. Are you on birth control? Have you ever been on birth control? Do you have difficulty urinating? Have you had urinary tract infection? Have you ever had kidney stones? Do you work with heavy metals? Have you ever had inflammation in the eyes? Have you had problems urinating? What medications have you taken during the past several months? (If yes) Why are you taking these medications? Do you have any long-term (chronic) conditions, such as asthma, arthritis, or lupus? c. What questions about the patients personal habits would be important to ask? Have you had problems with diet in the past? How many hours do you normally sleep? Are you maintaining a regular routine? Do you work? Have you been going to work? (questions for depression)

d. What questions about the patients family medical history would be important to ask? Was anyone in your family depressed? Is there a history of hypothyroidism in your family? Is there a history of obesity in your family? Has anyone in your family ever needed a kidney transplant? Has anyone in your family ever used a dialysis machine?

References

Bickley, L. S., Szilagyi, P. G., & Bates, B. (2007). Bates' guide to physical examination and history taking (9th ed.). Philadelphia: Lippincott Williams & Wilkins. McPhee, S. J., Papadakis, M. A., & Tierney, L. M. (2008). Current medical diagnosis & treatment, 2008 (47th ed.). New York: McGraw-Hill Medical. Uphold, C. R., & Graham, M. V. (2003). Clinical guidelines in family practice (4th ed.). Gainesville, Fla.: Barmarrae Books. Celiac disease - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/celiac-disease/DS00319 Colon cancer - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/colon-cancer/DS00035 Crohn's disease - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/crohns-disease/DS00104 Cushing's syndrome - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/cushings-syndrome/DS00470 Depression (major depression) - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/depression/DS00175 Diabetes - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/diabetes/DS01121 Food allergy - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/food-allergy/DS00082 Hypothyroidism - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/hypothyroidism/DS00353

Irritable bowel syndrome - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/irritable-bowel-syndrome/DS00106 Kidney failure, acute - MayoClinic.com. (n.d.). Mayo Clinic. Retrieved January 11, 2012, from http://www.mayoclinic.com/health/kidney-failure/DS00280