Deriving the initial hypothesis
In the case below you are given information and a photograph. On a separate piece of paper, using your text book, write up your pre-hypothesis summary statement, and your initial hypothesis. Check your answer by clicking the down arrow on the answer pull down below the case. Note differences between your answer and the answer below. Be certain you understand the differences.
You will need your text: "Oral and Maxillofacial Pathology" by Neville et. al.
Diane Mills, a 24-year-old caucasian female reports to your office:
CC: "Can you help me with this ulcer that started yesterday here on the inside of my cheek? I can't chew my food now, and I can't have it hurt while I'm driving down to Miami tomorrow for the East Coast Surfing Championships."
HPI: 2X3 mm, irregular, ulcer with red halo on left buccal mucosa at the level of the molars. Present about 24 hours. History of previous ulcers, same characteristics for 6 years. Usually painful for a week then heal in another week. Patient has problems eating when ulcers present because of pain.
MH: Treated on and off for chronic stomach ulcers over the past 8 years, medicated with Tagumet. Internationally competitive surfer for 10 years. Past 6 years her "real" job (a web site designer) has had more deadlines with heavier traffic on the internet. Pt has recently been diagnosed with mild hypertension, controlled with diuretic. BP today, normal.
DH: Regular dental care, several alloy restorations. Generally good dental care and currently in good dental health.
Note: Even if you think you know what the diagnosis is, write out your Initial hypothesis as if you didn't know.
PRE-HYPOTHESIS SUMMARY: MS Mills is a 24 y o competitive surfer who works as a web designer. She presents with a 2x3 mm irregular ulcer with a red halo on the left buccal mucosa of 24 hours duration. She has a 6 year history of similar lesions. Medical history: stomach ulcers for 8 years and recent diagnosis of hypertension. Meds: Tagumet, diuretic
1. traumatic ulcer
2. aphthous stomatitis
3. primary herpetic stomatitis
4. erythema multiforme
5. Becet Syndrome
6. aphthous herpetiformis