[ender18d]

Originally Posted by Brush Okie

Question on Hx.

Any Nausea and vomiting?

No.

Originally Posted by Brush Okie

Does the pain get worse after meals especially fatty meals?

No

Originally Posted by Brush Okie

Any abd pain or tenderness?

Abdomen appears unremarkable, is soft and supple in 4 fields w/ no guarding or rigidity. Bowel sounds auscultated.

Originally Posted by Brush Okie

Does he have a fever?

See vitals.

Originally Posted by Brush Okie

What is the malaria possibility in the region or has he been in a malaria region recently?

The patient is in a region with chloroquine resistant malaria, and is on prophylaxis as noted. The patient claims good compliance.

Originally Posted by Brush Okie

Any stiff neck or Sx of flu other than feels like shit and night sweats?

No nuchal rigidity noted. Negative NVD, cough, rhinorrhea, sore throat, etc.

Originally Posted by Sdiver

1) What country are you, is this pt. in?
2) Pt. states that father had Hx of Lower back pain. Was there any diagnosis on what caused his dad's back pain.
3) Can you in anyway, or is there any way to preform a spinal tap?
4) Does he c/o of a headache, head tilt to chin pain, bright lights bother him? (Going down the r/o Spinal Meningitis route here.)

1. Lets say sub-saharan Africa somewhere. I'm not picky for this scenario. Someplace hot that has malaria and a bunch of other bad things. Pick a country.
2. His dad was always complaining about his bad back that he got jumping into Market Garden, but no diagnosis that patient can recall.
3. Could you? Would you? (assuming you have the equipment to do the procedure)
4. Negative nuchal rigidity, photophobia.

Originally Posted by Sdiver

I've noticed that you've brought up quite repeatedly about the pt. having dental work done. Where was this work done at? In a regular DDS's office or some other place. I ask because if done in a regular DDS office, I know those chairs they use do NOT supply or support the Lumbar area. So this could have exasperated an underlying condition.

Work was done at a military dental facility.

Originally Posted by Sdiver

5) What procedure was done in the DDS office? Was he put under with anesthetic for a surgical procedure or was it just a regular cleaning of his choppers?

He says his mouth was a real cesspool according to the dentist, but he has trouble remembering any particular words. When you say "root abscess," he seems to think that rings a bell. Local anesthetic was used.

Originally Posted by Trapper John

So has Team Sergeant been drinking unpasteurized milk? Otherwise, I'm thinking the proximate cause for the osteomyelitis is the recent dental work.

Negative

Originally Posted by Scimitar

Amateur here...do let me know if I should stand down...

Has the pt had Chickpox as a child?
Has the pt been under greater than usual stress this past 1-2 months, prior to deploy?

S

Yes and yes. Mama ain't happy at home.

Originally Posted by Scimitar

Another question...how long has pt been on meds, the sweats / out of sorts can be the meds, taking these symptoms out of the mix.

PT has been taking lisinopril since his mid 30's. He started the malaria prophylaxis a few days prior to deployment.

Originally Posted by Scimitar

Also, any meds during dental work?

S

The patient does not know if the dentist used any meds other than anesthetic... he just remembers a bunch of needles. He was given a prescription for something by the dentist, but he didn't feel sick so he ignored it.