Vague or Multiple Complaints
Important Note
Ignore the vague complaints at everyone’s peril! Whenever you see/hear vague or multiple complaints – pay more attention!
In the younger patient it usually means there’s nothing seriously wrong. In the older patient it usually means there is! Often the “vague complaint” represents a change from normal and thus an indicator of something new, and potentially serious.
As one ages, the ability to localize a problem or a symptom, decreases (for reasons we’ll explore shortly) so the only symptom of depression or an MI or diverticulitis may be just “weak” and “not feeling right” and “poor appetite.”
- Watch these two videos of different people saying roughly the same words. Then answer the question.
- What is your differential diagnosis and management plan?
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- What is your differential diagnosis and management plan?
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Discussion: Vague or Multiple Complaints
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Vague complaints warrant further detailed history and physical
Vague complaints can be much more concerning in elderly as opposed to the younger patient.
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age definitely makes a difference in presentation and considerations of differentials
the elderly person you may have to assess past medical history and ask for input with family members or friends
I only see the young video
it is really good to have a comparison between the two.
good to see comparison between two similar presentations
good to see comparison between two
so different- nice to see for comparison
Great comparison of the two in different age groups
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age matters!
hard
two different women in different age groups but with sort of the same complaints. It’s very difficult to assess the problem when both are very vague.
interesting in how workup/management quickly changes
very good
Good learning points
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need more info. but same words from two different age groups have different “feeling” of Dx
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my oh my
yes interesting
need more info to tell for sure
videos are too vague and uninformative
with out more info, unfortunately its hard to tell with out knowing for sure
I’m just kiddin like Jason, unlessyougunnadoit
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mi
good point , young vs old patient with atypial complaints , with different workup and management plan
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good activity
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great information
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very helpful information.
good case
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agree, need more work up for the elderly lady.
Would keep the elderly ladies overnight for further workup.
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excellent
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Unable to complete because can’t see second video
thanks for the resources
Additional assessment data needed
Have to do some more assessing.
good comparison
wording
different age different dx spectrum
its all about the history
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detailed and thorough assessment and differentials
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great
younger people ven when they are vague it is easier to tease out information
general malaise
conduct a thorough assessment and blood work
Takes a lot more probing
I disagree with the “expert” that young women with vague c/o likely has “no serious diagnosis” – a young, otherwise healthy person presenting to an ER may be desperate for someone to help, including something like intimate partner violence. I understand the distinction you’re trying to make fore teaching purposes, but I’d reword the “expert’s” feedback.
I agree. It seems to me not being professional. If a young student in medecine read it, it is not the way to see it.
agree with you, maybe they should say “more likely to be non-life threatening”
continues to be thorough history and exam
Las quejas son vagas, creo que se debe recabar más información y pruebas de laboratorio para diagnosticar, examen físico
good vignettes
Good vignette
no access to second video, but the complaints from the first pt are too vague
the second video is not present but in the elderly I would consider MI, infection, gallbladder, depression, polypharmacy,
ACS, Viral syndrome, UTI, other infectious process
same complaint with difference in presentation
same words but different level of concern
vague complaints
Agreed. Tough presentation
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provide more questions
ask more questions
Yes
1st video: woman just feel tired
2nd video: patient is feeling more than being tired. may have a serious condition going on
If there’s a second video, it’s not coming up for me…
i’m not seeing the other video…
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good contrast… same complaint, but very different outcomes
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thanks
easier to come up with more differentials for the older lady
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agree
agreed
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the first case, she might show sign of MI as she describe fatigue but again further investigation must be done to have a definite diagnosis
the second case, also need further evaluation, another thing that I also notice she does appear pale, she might need anemic, diagnosis test should also be done also.
there are many
very nice
it is vital for us to take further investigations to narrow down the complaints.
More information will be needed from the elderly woman. She is describing vague symptoms. The provider will need to ask more questions to obtain pertinent information, review medications, check facility records, etc.
Very interesting how both pt’s present with vague symptoms. It is up to us to sort this all out and gather all the information we need
New territory lots to remember, uti, meds also a thought
True! we need to listen to all but focus more with key points
If you conclude the middle age has nothing with those information and don’t go further, you will miss a lot of diagnosis. Whatever the age, take a goood history and be cautious. I caught a myocardial infarction on a 30 year old psychiatric patient once.
age difference can have different workup and investigation
Recabar más información de manera adecuada
She doesn’t look especially well. Not overtly sick, but not well.
cannot assume it is as trivial as they present, a good Hx has to be obtained
vague complaints, further investigations is required.
I don’t feel well is not a basis for the beginning of a differential diagnosis
treat the elderly with respect. and a warm blanket.
difficult to pinpoint. elder needs further workup
History is critical here – take time to get a good history from the patient.
make sure that the patient don’t has other symptoms
hay que dar mas informacion
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🙂
CGA is vital
cool
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Old people may present with what appears to be something trivial but that could be the tip of iceberg. Always detailed history and exam will help.
Agree re age will dictate how aggressive our investigations and management will be
do you have a mnemonic for ddx for fatigue nyd
good point: young vs old pt. with vague complaints, very different workup and management plan.