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Formulating and justifying a differential diagnosis

  • April 14, 2021
  • Manyara2021
  • 339

A​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​ 15-year-old female presents to your clinic with her mother. The mother reports that her daughter has appeared low in mood, irritable, withdrawn, and exhausted for around six months. She also reports that her daughter often refuses to eat and has stopped engaging with most of her hobbies, as well as no longer seeing her friends. The mother is worried that the patient has lost a significant amount of weight during this time. You find that the patient has a Body Mass Index of 17kg/m2. The patient informs you that she is fat and that this means she is a failure. She reports running daily but is vague on the distance covered. The patient has not had a menstrual period for four months. The patient also reports that she does not understand why her mother is so concerned and has arranged for you to see her. She does, however, admit to recently having fainted whilst at school. Objectively, the p​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​atient appears very thin and pale, with fine downy hair and cold extremities. Discuss this scenario by: · Formulating and justifying a differential diagnosis · Presenting what you consider to be the most likely diagnosis, with justification. · Highlighting any investigations that you may consider arranging, with justification · Outlining a comprehensive evidence-based management plan that you would consider implementing (including reference to a multidisciplinary approach that also involves carers and the school) · Considering any other factors that you think may be of relevance to this scenario You should submit a comprehensive clinical report incorporating all of the aforementioned considerations in relation to this specific clinical scenario. It is recommended that you refer back to the scenario as a means of demonstrating your clinical reasoning and the rationale for your r​‌‍‍‍‌‍‍‌‍‌‌‍‍‍‌‍‌‌‌‍​eport
 

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