What is the diagnosis and management of a middle-aged woman with dizziness and palpitations, and how to interpret her Electrocardiogram (ECG)?

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Differential Diagnoses for Provided Scenarios

Scenario 4: Erectile Dysfunction

  • Single most likely diagnosis:
    • Psychological causes (e.g., stress, relationship issues) given the patient's work schedule and wife's unhappiness.
  • Other Likely diagnoses:
    • Vascular diseases (e.g., atherosclerosis) due to the potential for late hours and possible lifestyle factors contributing to vascular health.
    • Neurological issues (e.g., neuropathy) that could be related to lifestyle or underlying health conditions.
  • Do Not Miss:
    • Diabetes mellitus, as erectile dysfunction can be an early sign, and missing this diagnosis could lead to delayed treatment of a significant health issue.
    • Hypertension, given its impact on vascular health and potential contribution to erectile dysfunction.
  • Rare diagnoses:
    • Hormonal imbalances (e.g., low testosterone), which could be a less common but significant cause of erectile dysfunction.
    • Certain medications or substance use that might contribute to erectile dysfunction.

Scenario 7: 9-month-old child with weight concern

  • Single most likely diagnosis:
    • Failure to thrive (FTT), given the child's weight is a concern at 9 months.
  • Other Likely diagnoses:
    • Inadequate nutrition or feeding issues.
    • Gastrointestinal issues (e.g., reflux, infections) that could lead to poor weight gain.
  • Do Not Miss:
    • Congenital heart disease or other cardiac issues, as these can lead to failure to thrive and are critical to diagnose early.
    • Metabolic disorders (e.g., cystic fibrosis), which could explain poor weight gain and require early intervention.
  • Rare diagnoses:
    • Genetic disorders (e.g., Prader-Willi syndrome) that could affect growth and development.

Scenario 9: 36-week pregnant woman with itchy rash

  • Single most likely diagnosis:
    • Pruritic urticarial papules and plaques of pregnancy (PUPPP), given the description and gestational age.
  • Other Likely diagnoses:
    • Polymorphic eruption of pregnancy (PEP), another common dermatosis in pregnancy.
    • Intrahepatic cholestasis of pregnancy (ICP), which can cause itching but typically without a rash.
  • Do Not Miss:
    • Intrahepatic cholestasis of pregnancy (ICP), as it can have significant implications for fetal health and requires prompt diagnosis and management.
    • Pemphigoid gestationis, a rare autoimmune blistering disease that can be dangerous if not treated.
  • Rare diagnoses:
    • Other autoimmune diseases (e.g., pemphigus) that could present with a rash during pregnancy.

Scenario 10: Young male with leg pain on walking

  • Single most likely diagnosis:
    • Intermittent claudication due to peripheral arterial disease (PAD), especially given the patient's smoking history.
  • Other Likely diagnoses:
    • Musculoskeletal issues (e.g., shin splints, stress fractures) that could cause leg pain with activity.
    • Nerve compression or neuropathy.
  • Do Not Miss:
    • Deep vein thrombosis (DVT), as it is a medical emergency that requires immediate treatment.
    • Acute arterial occlusion, which is also an emergency.
  • Rare diagnoses:
    • Popliteal artery entrapment syndrome, a rare condition that can cause claudication in young individuals.

Scenario 11: Young male with submandibular lymph node pain

  • Single most likely diagnosis:
    • Viral pharyngitis or tonsillitis, given the acute onset and location of pain.
  • Other Likely diagnoses:
    • Bacterial infections (e.g., streptococcal pharyngitis).
    • Dental infections or abscesses.
  • Do Not Miss:
    • Tuberculosis (TB), as it can present with lymphadenopathy and is a significant public health concern.
    • Malignancy (e.g., lymphoma), which is rare but critical to diagnose early.
  • Rare diagnoses:
    • Cat-scratch disease, a rare bacterial infection that can cause lymphadenopathy.
    • Other infectious diseases (e.g., toxoplasmosis) that could cause similar symptoms.

Scenario 12: Young lady with past chlamydia infection

  • Single most likely diagnosis:
    • None specifically, as the task is to advise on testing for sexually transmitted infections (STIs) given her past infection and new relationship.
  • Other Likely diagnoses:
    • Reinfection with chlamydia or other STIs (e.g., gonorrhea, syphilis) due to her past history and new sexual partner.
  • Do Not Miss:
    • HIV, as it is a critical diagnosis that requires early detection and treatment.
    • Other STIs that could have long-term health implications if not treated.
  • Rare diagnoses:
    • Less common STIs (e.g., genital herpes, human papillomavirus) that she might be at risk for.

Scenario 13: 82-year-old lady with hip surgery and wedge fractures

  • Single most likely diagnosis:
    • Osteoporosis, given her age, gender, and history of fractures.
  • Other Likely diagnoses:
    • Osteopenia, a condition of low bone mass that is less severe than osteoporosis but still increases fracture risk.
  • Do Not Miss:
    • Malignancy (e.g., metastatic bone disease), as it can cause fractures and is critical to diagnose.
    • Other metabolic bone diseases (e.g., osteomalacia) that could contribute to fracture risk.
  • Rare diagnoses:
    • Rare genetic disorders affecting bone health (e.g., osteogenesis imperfecta).

Scenario 14: Eye examination findings

  • Single most likely diagnosis:
    • Not specified, as the scenario lacks details on the findings.
  • Other Likely diagnoses:
    • Refractive errors (e.g., myopia, hyperopia) if the examination reveals vision problems.
    • Age-related macular degeneration (AMD) or other age-related eye diseases if the patient is older.
  • Do Not Miss:
    • Glaucoma, as it is a leading cause of blindness and requires early detection and treatment.
    • Diabetic retinopathy, especially if the patient has diabetes.
  • Rare diagnoses:
    • Inherited retinal diseases (e.g., retinitis pigmentosa).

Scenario 15: Old lady with cognition impairment post-surgery

  • Single most likely diagnosis:
    • Postoperative cognitive dysfunction (POCD), given her recent surgery.
  • Other Likely diagnoses:
    • Pre-existing dementia or cognitive impairment that may have been exacerbated by surgery.
  • Do Not Miss:
    • Delirium, as it is a common and serious condition in elderly patients post-surgery.
    • Stroke or other cerebrovascular events that could cause cognitive impairment.
  • Rare diagnoses:
    • Rare metabolic or infectious causes of cognitive impairment (e.g., vitamin B12 deficiency, neurosyphilis).

Scenario 16: Middle-aged lady with dizziness and palpitations

  • Single most likely diagnosis:
    • Anxiety or panic disorder, given the symptoms of dizziness and palpitations.
  • Other Likely diagnoses:
    • Cardiac arrhythmias (e.g., atrial fibrillation) that could cause palpitations.
    • Hypertension or other cardiovascular conditions.
  • Do Not Miss:
    • Myocardial infarction (MI) or acute coronary syndrome, as these are medical emergencies.
    • Pulmonary embolism (PE), which can cause dizziness and palpitations and is life-threatening.
  • Rare diagnoses:
    • Pheochromocytoma, a rare tumor that can cause episodic hypertension, palpitations, and dizziness.
    • Other endocrine disorders (e.g., hyperthyroidism) that could cause similar symptoms.

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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