You Make the Diagnosis
Case 1
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Patient presents with lower back pain that is unrelated to position. He states the pain started insidiously one week earlier. Your choices of diagnosis are:

  • 1. Degenerative disk condition
  • 2. Abdominal aortic aneurysm
  • 3. Lumbar spine strain
Case 1 Answer

Patient presents with lower back pain that is unrelated to position. He states the pain started insidiously one week earlier.

Answer: Abdominal aortic aneurysm

  • This patient was referred to a vascular surgeon who repaired this with a dacron tube. He lived four more years.
  • AAA is a ballooning of the major artery in the abdomen. This develops in 6 to 10% of people older than 60 years of age. Once they reach a size of 4.5 to 5.5 cm they are usually repaired.
  • This currently accounts for 15,000 deaths a year.
  • Case 2
    case 2

    Patient presents with chronic lower back pain that is persistent a number of years. The pain has worsened recently and after a knee replacement. Physical findings: She can bend but leans to one side. A rib hump is noted upon flexion. Your choices of diagnosis are:

    • 1. Sprain/Strain
    • 2. Scoliosis
    • 3. Sprain/Strain complicated by a scoliosis
    Case 2 Answer

    Patient presents with chronic lower back pain that is persistent a number of years. The pain has worsened recently and after a knee replacement. Physical findings: She can bend but leans to one side. A rib hump is noted upon flexion.

    Answer: Sprain/strain complicated by a scoliosis

  • This patients recent knee replacement affected a slight change to the curve of the spine by changing the height of the right leg.
  • Scoliosis is a curvature of the spine. It is important to discover a curve in children so measures can be taken to stop or slow the curve.
  • In the elderly, curves can increase several degrees every year with degenerative changes of the spine.
  • Case 3
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    The patient is a 90-pound female who was standing on a table to clean on top of the cupboards when she fell, landing on her back. Pain is only present when she moves, otherwise she is comfortable. Your choices of diagnosis are:

    • 1. Sprain/Strain
    • 2. A disk injury
    • 3. Compression fracture of the vertebra
    Case 3 Answer

    The patient is a 90-pound female who was standing on a table to clean on top of the cupboards when she fell, landing on her back. Pain is only present when she moves, otherwise she is comfortable.

    Answer: Compression fracture of the vertebra

  • Vertebral compression fracture secondary to trauma and osteoporosis.
  • This patient was placed on calcium supplements along with Vitamin D.
  • She went on to have several more falls without fractures. She lived to be 93.
  • Osteoporosis:

  • Affects 10 million people in the US.
  • 1.5 million people in the US have a fracture every year.
  • 700,000 are in the spine.
  • 300,000 are in the hip.
  • 200,000 are in the wrist.
  • Case 4
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    The patient is seeking care for a strain condition of her lower back. A routine blood test results are pictured. Your choices of diagnosis are:

    • 1. Hyperlipidemia
    • 2. Hypercholesterolemia
    • 3. Normal lab
    Case 4 Answer

    The patient is seeking care for a strain condition of her lower back.

    Answer: Hyperlipidemia


  • This patient had severe hyperlipidemia with the triglycerides at 1124. After treatment with supplements, her triglycerides improved to 359 for a period of 5 years. At this time 200 was considered normal. This was achieved without a statin drug!
  • Triglycerides are a fat. Cholesterol is not.
  • Independent elevation of Triglycerides are a risk factor for heart disease.
  • Usually accompanied by Low HDL (good cholesterol) and high LDL (bad cholesterol).
  • Case 5
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    This is an eight year old boy who has been unresponsive to antibiotics for a chronic middle ear infection (otitis media) and strep throat. Allergy testing results are pictured. Your choices of diagnosis are:

    • 1. Allergy to milk
    • 2. Allergy to dairy, avoid all dairy for 2 months
    • 3. Allergy to dairy, avoid all dairy for 1 year and retest him
    Case 5 Answer

    This is an eight year old boy who has been unresponsive to antibiotics for a chronic middle ear infection (otitis media) and strep throat.

    Answer: Allergy to dairy; avoid all dairy for 1 year and retest him


  • His ear infection cleared up. He has been able to return to drinking milk without complaints.
  • The testing was done by fasting blood analysis known as ELISA, which stands for Enzyme Linked Immunosorbent Assay.
  • This is an allergy test which detects IGG-IGA- IGM.
  • This testing resulted from forensic science.
  • The standard R.A.S.T. test detects IGE.
  • Case 6
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    Patient is under your care for a strain condition. He states that he fell off his motorcycle when he passed out. A Duplex Doppler ultrasound of the carotid artery branching in to the internal is pictured. Your choices of diagnosis are:

    • 1. Normal ultrasound of the carotid arteries
    • 2. 70% to 80% blockage of the internal carotid artery with cardiovascular insufficiencies
    • 3. Stay off the motorcycle
    Case 6 Answer

    Patient is under your care for a strain condition. He states that he fell off his motorcycle when he passed out.

    Answer: 70% to 80% blockage of the internal carotid artery with cardiovascular insufficiencies

    case 6 answer
  • This patient has a narrowing of his internal carotid artery secondary to an atherosclerotic plaque.
  • We referred him to confirm the narrowing.
  • We provided supplementation for Hyperlipidemia and sclerotic disease since this finding.
  • His Doppler hasn’t changed since his initial exam.