b'SCIENTIFIC ASSEMBLY PACEP 2023 CPC HIGHLIGHTWhat is the Diagnosis?A special thank you to Alexandra Amaducci, DO, FACEP for organizing the CPC competition during Scientific Assembly and to Shelby Crowley, DO from TowerHealth for submitting the case and being the resident presenter, and Steve Schirk, MD, FACEP from Wellspan York for being the attending discussant.CPC CASE The Case58-year-old male patient presented with 6 days ofSTUDY fever and abdominal pain and states I have typhoid feverTHE CASE Tmax 102 F LABS:The fever was preceded by abdominal pain and one day of vomiting CBC w/ diffAbdominal pain is right sided and radiates to left flank Hgb 15.4 Patient reports he was recently diagnosed with typhoid fever afterHematocrit 46.1WBC 7.3traveling to Africa for missionary work Platelet 217 Patient has been taking 2,000mg of acetaminophen q4 hours CMPGlucose 83Albumin 4.1PMH: DVT, PEBUN 13Calcium 9.2PSH: hernia repairCr 1.01Protein total 7.2SocHx: never smoker, denies alcohol or drug useSodium 139Bilirubin 0.6Potassium 4.3 AST 58Allergies: none Chloride 103ALT 82Current medications: ciprofloxacin, cefixime, Xarelto, mefloquineBicarb 24.9Alk Phos 81ROS:Pertinent positivenight sweats, decreased appetite, fatigue,AG 11SOB, decreased urinary outputTHE WORKING DDX: PE:VS:RR 30, 97% on RA, BP 128/75, HR 101, Temp 99.7F Anatomic/Structuralbowel Constitutional: ill-appearing, no diaphoresis obstruction, gall bladder/biliary tract, HEENT: moist mucus membranes. Mild pharyngeal erythema pancreatitis, appendicitis, diverticulitis,Cardiovascular: tachycardia. No murmurureteral obstruction (with or without pyelonephritis, trauma, some type ofPulmonary:no respiratory distress. Slight expiratory wheeze withthromboembolic processno rales or rhonchi Oncologiclymphoma or some other typeAbdominal: soft, mildly distended. Right sided, non-focalof malignancy Endocrinethyroid diseaseabdominal tenderness to palpation, with no rebound or guarding. Toxinacetaminophen, interaction of No CVA tenderness to b/l. meds, poisoningExtremities: symmetric non-pitting edema b/l. no calf tenderness. InfectiousbroadMusculoskeletal: Normal range of motion and neck supple.Leptospirosis(Malaria)Neurological: A & O x3. No focal neurologic deficits. SchistosomiasisEbola African Sleeping SicknessMarburgSkin: warm and dryAfrican Tick Bite FeverMonkey poxPsych: Calm and cooperativeChickungunyaHantavirus DengueTuberculosis(TB)What test will make the diagnosis?What is the final diagnosis?see conclusion on page 23PACEP News | Fall 2023 19'