19 Sep 2. Each student will choose one of the cases below
2. Each student will choose one of the cases below. When making your choice from the list, please verify that you have selected a case not already chosen by another student. There will be some duplication of choices but make an effort to have each topic selected at least once (if possible). Cases – 58-year old Laurine is complaining of 1 hour history of epigastric pain unrelieved with Tums. Past medical history includes Diabetes Mellitus 2 and she is taking Metformin 1000mg BID. Last HgA1C was 8.0 (down from 10). BP 140/90, pulse 52, resp. 24. – 68-year old Louis is complaining of shortness of breath and left chest pain for 48 hours. He is a cigarette smoker and takes a “pink pill” for hypertension. His blood pressure is 160/80 and respirations are shallow at 22/minute, due to the chest pain. Heart rate is 110 and regular. During the interview, he offhandedly mentions that he fell from his ladder 1 week ago while trimming a tree. – 45-year old Miguel reports 2 hour history of severe left lower and mid-chest pain that radiates to the back. He attended his best friend’s bachelor party last night and got into a bar fight. “I really do not remember everything that happened.” – 24-year old Lucy is complaining of lower right chest pain, shortness of breath, nausea and vomiting x1. The symptoms started this morning after she ate breakfast and have progressively worsened over the past 3 hours. Significant past medical history is that she was discharged yesterday from the hospital after delivering a healthy male child (normal vaginal delivery) 3 days prior. – 82-year old Ruth presents with new onset cough. Her daughter reports that her mother has less energy than normal and that she is confused. Vitals signs: Temp 37degrees C (axillary), Pulse 120, BP 100/50, Resp 32 – 3-week old Joseph is brought to the clinic by his mother. She reports that Joseph has been coughing for the last few days, worse after feeding, to the point that he sometimes vomits his food. Temp 37.4C (rectal), pulse 155, respiration 64. – 8-year old Alicia, accompanied by her mother, is complaining of a recurrent cough that is worse at night for the past 3 weeks. Alicia has a history of seasonal allergies (diagnosed age 4) for which she takes Ceterzine chewable, 10mg prn. Mom is also reporting that Alicia has 3 days of nasal drainage that is thin, and clear to yellow in color. – 62-year old Helen reports a chronic cough, worse in the morning, accompanied by thick white sputum, “sometimes with flecks of blood in it” for 3 years. She has not sought medical care because she had no insurance. She recently applied for and received insurance under the Affordable Care Act. The cough is interfering with her ability to work as a waitress. – 38-year old Alex is homeless and presents to the clinic with fever, a productive cough and general malaise. He smokes cigarettes, weed, “crack when I can get it,” and has a history of IV drug use. “I have been clean for a year from the needle.” The cough started about a month ago and has progressively worsened over time. It is productive with yellow, green mucous. – 17-year old Lucy reports a 1 month history of shortness of breath with exertion, fatigue and feeling lightheaded when she changes positions. She has no cough but does report exertional chest pain that is relieved with rest. She does not smoke, use illegal or prescription drugs and she is in a monogamous relationship with a boyfriend of 1 year. She is an A student and likes high-school, although she has had difficulty keeping up with her extracurricular activities due to the above noted symptoms. 3. Once you have chosen the case, you will answer the following questions: – Identify 3 initial differential diagnoses based upon the patient’s presentation and chief complaint. – Briefly explain the pathophysiology associated with each of the 3 diagnoses you have chosen. – What specific history questions would you ask to rule in or out each of the above diagnoses? (provide brief rationale for your questions)? – What specific components of the physical exam are most pertinent to rule in or out each of above diagnoses (provide brief rationale for your answer)? – What are the expected history and physical exam findings for one diagnosis (choose one that you think it the most likely diagnosis for the case and provide a brief rationale for your answer). – What diagnostic study(s) (if any) would you order to rule in the one diagnosis that you have chosen? Support your study(s) choice with a clinical guideline, professional group recommendation or other evidence from the literature. – Name one medication you would order to treat the one diagnosis you selected. Write a prescription for the medication (even if it is over-the counter). Support your choice with a clinical guideline, a recommendation from a professional group or with other substantial evidence from the literature. The use of Epocrates or similar internet program to support your decision is not permitted. – Briefly describe the education you would provide to the patient, in language that the patient will understand, regarding the diagnosis you have made, the study(s) that you are going to recommend, the medication you ordered, and the follow-up needed. 4. Respond to at least 2 other students before Sunday of Week 5. 5. Cite your sources according to APA format. Provide references for your sources
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