Can you solve this clinical case?

A 57 year old female presented at the urgent care center with severe foot pain and a swollen and erythematous toe which has developed over the past day.

Q. 1 – Which of these would be in your differential diagnosis workup?

Tarsal tunnel syndrome

Necrotizing fasciitis

Gout

Rheumatoid arthritis

Two days later the patient returns to the urgent care centre with worsening pain, despite bed rest and medication. She has also noted red streaks running up her leg and past her knee. These marks are confirmed on examination.

Q. 2 – With this new information which is the most likely diagnosis? (Select one)

Tarsal tunnel syndrome

Necrotizing fasciitis

Gout

Isabel would have helped you work up your differential, flagging necrotizing fasciitis as a 'more likely' diagnosis from the beginning, and helping you reach the correct diagnosis in seconds:

Commentary

Using Isabel, you can see necrotizing fasciitis remains top of the diagnosis list from the beginning, and all the other diseases considered move further down the list when additional and worsening symptoms are entered. This was a real case, assessed by a Physician’s Assistant who diagnosed gout in the first instance, without considering the potentially life threatening possibility of necrotizing fasciitis. Had she considered the other possible diagnoses in the differential, the patient may not have had to undergo life changing surgery where soft tissue had to be removed from the leg in order to control infection. This resulted in a below the knee amputation. A malpractice lawsuit was filed against the Physician Assistant and he was found to have breached the standard of care.

Q 3. Would you be more likely to use Isabel to help with your differential diagnosis having done this quiz?

Yes

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