Diagnosis Defense Presentation

Length

3–4 minutes

Audience

Healthcare peers

Prompt

Choose a hypothetical diagnosis related to the cardiovascular or immune system. Deliver a prepared oral presentation in which you:

• Clearly state the diagnosis (central message)

• Support your claim using appropriate medical terminology

• Explain your reasoning using signs, symptoms, or system function

• Organize your presentation logically and professionally

• This presentation should resemble how a healthcare professional explains and defends a diagnosis to colleagues.

Response

I recently diagnosed a forty-one year old patient with stage 1 hypertension. The patient came in complaining mysterious headaches.

When asked about the triggers, the patient reports the headaches often occur when lying down. The patient also self-reports no history of migraines, or traumatic brain injury.

The patient's pre-check has them at a normal BMI, which a blood pressure of 135/85. When asked about the blood pressure, they patient says they are anxious and it's not normally this high. When asked about neck pain, fever, or personality changes, the patient reports none. The patient has a normal sensitivity to both light and sound.

When asked about the headaches, the patient reports a slight throbbing sensation in and around the temples, accompanied with flickering vision. I asked about the patient's vision and they report it has been steadily declining for years. They suspect their vision is somehow worse than their peers, despite wearing contacts.

The patient has fundus photos from a recent eye appointment, which show mild arteriovenous nicking. Arteriovenous nicking is not normal in a 40 year old patient, and is a common sign of hypertension in the head. To follow-up on their blood pressure, I sent the patient to get their blood pressure readings from each of the doctors they have been to over the last five years.

The patient also brought in their own blood pressure readings they have been taking at home. The at-home blood pressure readings generally showed values in range of normal, however their in-office blood pressure readings consistently showed values between 130-140 systolic in the low-80s for the diastolic. The patient explains this by saying other doctor's have told them that they have whitecoat syndrome. Meaning that they get anxious at a doctor appointment, causing their blood pressure to read higher than normal.

The next appointment, I had the patient bring in their blood pressure cuff so we could compare it to the one we have in-office. The two devices disagreed with each other, the patient's blood pressure cuff was underestimating the patient's blood pressure by about 15 millimeters of mercury.

Thus, the patient has been diagnosed with stage 1 hypertension.

Diagnosis

Hypertension

Symptoms

Patient complains of decreased visual acuity. Sees an increased number of floaters.

Signs

Fundus photos show signs of arteriovenous nicking.