Hi guys , As I suppose you guys who are taking step 3 must already be really good at what you are doing.
I have a question about a patient.
Ideas please !
- 27 year old female complains of a Sharp pain near her lower ribs. Usually left and sometimes Right sided too.
-she has this pain for 4 years already and never gone to doctors. - She start going to doctors recently ,
They did Spine MRI - No issues
Brain MRI - No issues.
When she got KENOLOG spine shot she totally felt pain less , She never had that feeling in past 4 years.
But , After 2 weeks , Pain started again.
Got same shot in spine again , Lost all her pain again.
We can’t really diagnose what’s going on.
-CRP - Increased.
Lymphocytosis 
Luecocyturia
B12 Levels are low.
- She had 3 surgeries to her ears , Tubes and Skin grafts
- She is 48Kgs , 5’4.
-has Temporo Mandibular Joint issues. - Had arthritis
- Rheumatoid factor is absent
H.pylori negative
Echo CG and ECG are Perfectly normal.
Chest X ray is normal.
Ultra sound of all abdominal organs reveals a slight thicknening of Gall bladder.
Had Cysts in her genital area somewhere that have been treated.
Complains that sitting on hard surfaces for long time exacerbates the pain.
Stool test is normal.
She complains about Ear pressure now and also Headache sometimes.
-Went to ENT , Says everything is fine. Audiometry is normal too.
Neurologists say everything is fine.
Still can’t diagnose her Ribs pain nor ear pain