03-26-2011, 09:53 AM
A 68-year-old white man comes to the office because of progressively worsening right groin pain for the past month. You last saw the patient 3 months ago for preoperative assessment for a total right hip replacement. For the past 5 years he has been treated with inhaled bronchodilators for emphysema resulting from an extensive history of smoking cigarettes. The patient is widowed and has lived alone in a mobile home since his wife died 4 years ago. Vital signs today are temperature 36.8°C (98.2°F), pulse 66/min, respirations 18/min, and blood pressure 110/82 mm Hg. Physical examination shows an unkempt man who appears much older than his stated age. He has evidence of alcohol on his breath; dentition is poor with several broken, loose teeth, and gingival pyorrhea is present. Lung sounds are distant and air entry is poor. Heart and abdomen are normal. There is no hernia present in the groin. With the exception of testicular atrophy, the patient's genitalia are normal. Which of the following is the most likely initial working diagnosis?
1. A.
Iliac venous thrombosis
2. B.
Infected hip prosthesis
3. C.
Occult appendicitis
4. D.
Occult hernia
5. E.
Somatoform disorder
What is your thought process? Can you please explain. Thanks
1. A.
Iliac venous thrombosis
2. B.
Infected hip prosthesis
3. C.
Occult appendicitis
4. D.
Occult hernia
5. E.
Somatoform disorder
What is your thought process? Can you please explain. Thanks