Solve the Medical Riddle: She Itches All Over Even Though She has No Rash or Hives, Second Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

Last week, the patient reported her symptoms. The doctor proceeded with the examination using the components of the classic S-O-A-P notes, which are as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The doctor also ordered blood work and other tests and asked Nancy to return for a complete physical after getting the test results. This week, we’ll learn what happened during that return visit.

At the second visit, during a complete physical exam, Nancy’s doctor found enlarged lymph nodes along the left side of her neck. This condition is called lymphadenopathy, meaning nodes of abnormal size. He ordered a biopsy of the enlarged nodes, although they were not causing Nancy any pain. The doctor found no other abnormalities during the complete physical exam. Nancy’s liver was normal and her spleen was not enlarged.

The results of Nancy’s tests were as follows:

• Her blood work showed only mild anemia with normal iron levels and mild increased white blood count.
• Her spleen was not enlarged.
• Her chest X-ray showed a suggestion of lymphadenopathy.

To be continued . . .

Come back to ThirdAge.com next Thursday to find out what some people have guessed the diagnosis might be.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.