These are the 3 textbooks:
CURRENT Diagnosis & Treatment in Family Medicine, 5th Edition (Required)
McGraw-Hill Education / Medical; 5th Edition
ISBN-10: 126013489X
ISBN-13: 978-1260134896
Rapid Interpretation of EKG (Required)
Cover Publishing Company, Tampa, FL., 6th Edition
ISBN-10: 0912912065
ISBN-13: 978-0912912066
Laboratory and Diagnostic Tests with Nursing Implications (Required)
Boston, MA: Pearson, 10th edition
ISBN-13: 978-0134704463
ISBN-10: 9780134704463
There are 6 discussions in total.
Case Study 1 Discussion
Chief Complaint:
Mrs. Garcia a 62 year old female with a history of chronic gastritis presents today to your primary care office with complaints of weakness, fatigue, burning sensation in the tongue, paresthesias to bilateral lower extremities, and memory loss. Patient reports symptoms began more than 3 months ago. She admits to drinking 1 bottle of wine on a daily basis to “relax her nerves”.
Patient Medical History:
Hypertension, osteopenia, chronic gastritis
Review of Systems
Uses glasses for distance and reading. Hard of hearing. Occasional episodes of short term memory loss. Fatigue and short of breath when laying down and with exertion at times. She has occasional palpitations. Reports her bowel movements are normal and denies any melena or blood in the stool.
Screenings:
Mammogram and colonoscopy are up to date and were all unremarkable. Dual energy x-ray absorptiometry scan shows osteopenia.
Surgical History:
Denies any surgical procedures.
Allergies:
NKDA
Medications:
Omeprazole 20 mg po daily
Calcium carbonate (OsCal) with vitamin D twice daily
Physical Exam:
Appears disheveled, thin and frail. Skin is pale. Bilateral conjunctivae appear pale. She is mildly short of breath at rest but in no apparent pain or distress. She is 5 feet 2 inches tall and weighs 100 pounds. The patient wears glasses for distance and reading. Her oropharynx is clear, and her neck is supple. There is no lymphadenopathy. Lungs are clear. Heart: S1-S2, Systolic 2+ murmur in the left MCL. The abdomen is soft, non-tender. BS are positive x4 quadrants. No masses palpated. Decreased sensitivity to bilateral lower extremities
Vital signs:
Blood pressure of 100/72 mm Hg; pulse 90 beats/minute; temperature 97.4 degrees F; respirations 20 breaths/minute; and oxygen saturation 93%.
Answer the following questions:
What is your differential diagnosis?
What is your working diagnosis?
You then order labs and these are the results on the subsequent visit:
Complete Blood Count
RBC
3.2 million/microliter
Hemoglobin
10.5 g/dL
Hematocrit
32%
MCH
41 microliter
MCHC
42%
MCV
115 microliter
Leukocytes
5,700 cells/mcL
Serum iron
90 mcg/dL
Total iron binding capacity
300 mcg/dL
Transferrin
250 mg/dL
Reticulocyte count
0.3%
Stool for occult blood
Negative (three samples)
Chemistry profile
Normal
Answer the following questions:
Which lab values are normal, and which lab values are abnormal?
Explain the significance of each abnormal result?
What type of anemia does this patient most likely have and what further lab(s) would you order to confirm your diagnosis?
Discuss your treatment plan if the lab(s) ordered to confirm the diagnosis are positive. (Be specific to your diagnosis).
What is your follow up?
**Provide References**
Case Study 2 Discussion
A 11 year old female presents to the Emergency Department with her mother complaining of abdominal pain and has had several episodes of emesis over the last 3 hours. Her current weight is 110 lbs with a body mass index > 85th percentile. Her mother states that she is extremely tired and has not been acting like herself for the past 3 days. Upon further questioning, you note that despite the patient’s recent increase in appetite, she has actually lost weight. The patient has been asking for several glasses of water per day and has had new-onset nocturnal enuresis.
Her vital signs include a heart rate of 105 beats/min, a respiratory rate of 24 breaths/min, a temperature of 37.5C (99.5F) and a blood pressure of 101/60 mm Hg.
What is the most likely diagnosis?
What are your differential diagnoses?
What labs/diagnostics would you order?
What is the sensitivity and the specificity of your tests ordered?
What is the general treatment for this condition?
What referrals would be warranted for a child with this condition?
What complications can be seen with this condition?
What education and anticipatory guidance should be provided at this visit?
Case Study 3 Discussion
Clinical Note
Age: 58 Sex: M Date
Chief complaint “Pain on my chest” on and off for the past six months.
History of present illness Mr. Solomon is a 58-year-old insurance broker who presents tonight in the office following an episode of “chest pain” that he experienced earlier in the day during a golf game. Although he minimizes the severity of the pain and attributes it to being “out of shape,” his wife insisted that he see a physician because he has had similar episodes during the past six months.
Mr. Solomon describes the pain as being more of a discomfort or heaviness. It is localized to “my breastbone” and does not radiate. Today, following a brief rest, the pain subsided, and he returned to his golf game. Previous episodes of the heavy feeling tended to occur following large meals and one occasion while dancing at a wedding. None of the episodes lasted more than “several minutes.”
Although Mr. Solomon did not experience nausea or vomiting today, he notes many episodes in the past of feeling a burning sensation in his chest. He describes the sensation as being “like acid behind my breast bone.” This feeling occurs most often late at night when he lays down. Usually he has had a large meal or drank alcohol. The sensation does not radiate.
Patient’s perspective: When asked about how he feels about these episodes, he admits to being concerned about his health and longevity, considering his father died at age 52 of “heart problems.” He says, business is poor, my kid is always in trouble. “Who’s going to take care of things?
Past Medical history: Not significant
Family history: hypertension (father), Mother Alive and well.
Social history: Smoker 1 PPD X 30 years
Medications: Vitamins
Allergies: None
Review of systems: No significant problems
Examination: Mr. Solomon is a short, moderately obese man who appears somewhat anxious but is in no apparent distress. He is wearing clean casual shirt/pants. Vital sings: BP right arm 162/94; left arm 160/92. Weight 176lbs; Height 5’7”. Respiratory rate is 16/minute. Temperature, 98.4 F.
Neuro: Alert, Awake, Oriented X 3. No acute distress
Neck: Supple, No JVD or bruits noted
Lungs: Clear bilaterally, no adventitious sounds
Cardiovascular system: reveals a regular, apical heart rate of 86/minute. S1 is heard best at the apex; a loud S2 is heard best in the R2ICS and L parasternal border. A questionable S4 is heard at the apex. There are no murmurs or apical prominence.
Abdomen: soft, non-tender Bowel sounds positive all four quadrants
Extremities: Pulses 2+ all extremities with no peripheral edema
Laboratory Tests:
CBC: WBC = 5,600/mm3, hemoglobin = 15.2g/dL, hematocrit = 45%, platelet count = 320,000/mm3
Chemistries: Glucose 110mg/dL, Blood Urea Nitrogen (BUN) 11mg/dL, Creatinine 0.9mg/dL
Urinalysis: Specific gravity: 1.016; Protein, Glucose, Ketones = negative.
Chest X-ray: normal
CT of the chest: Moderate hiatal hernia, lungs clear
Questions:
What is the pathogenesis of coronary artery disease?
What are the patient’s risk factors (modifiable and Nonmodifiable)?
What is your diagnosis, differentials?
Differentiate the diagnosis of chest pain and angina? (Be specific)
What treatment would you order (Be specific)
What further test would you order and provide rational? (Be specific)
Does this patient need a referral?
Case Study 4 Discussion
Patient Name: HD
Date of Birth: February 14, 1954
Purpose of visit: new patient
CHIEF COMPLAIN – Appointment for physical examination
HISTORY OF PRESENT ILLNESS:
67 y/o female who comes to the clinic for a scheduled physical examination. Patient has a history of Type 2 diabetes mellitus and a history of elevated blood pressure for about 3 years respectively. Patient has not consistently taken any medications and does not have any treatment for the past year. When asked about her medication regimen, “I do not recall, that is why I came here”. Upon assessment, 2×2 noted on forearm, when removed open wound, 1inch x 1inch of size, with serosanguinous and yellowish discharge. Skin around wound is hard and warm to touch. When asked patient, what happened? Patient stated that a dog bit her 2 days ago. Also, patient removed her shoes and showed healthcare provider her left great toe, which is red, painful to touch with a yellowish foul discharge. Patient has not been at the doctor or emergency room to be checked and refuses to go anywhere else.
Vitals: 170/110, HR 92, EKG SR with PAC’s. Fingerstick: 330mg/dl. Dipstick, +
leukocytes, glucose +++, ketones++ and glucose ++++, Temp- 100.5
height 5’8” weight: 210Lbs
Past medical history: bilateral knee replacement
Social history: smokes 1 pack of cigarettes daily, drinks 3 beers a day
Lives alone, unemployed now
Allergies: NKA
Head to toe assessment completed.
General appearance: good body habitus, well-developed, over weight
Skin: Skin color appropriate for race, turgor brisk. No rashes or lesions.
HEENT: PERRL, EOM intact, good dentition, no pallor or icterus.
Neck: dark area noted on back of neck
Cardiac: Regular rate and rhythm, S1 S2 with no murmur, gallop, or rub.
Lungs: rhonchi bilaterally, slightly diminished on bases
Abdomen: Soft, non-tender, obese, active bowel sounds in all 4 quadrants.
Extremities: upper extremities wounds. Left great toe red with oozing yellowish discharge ( wounds described previously)
Pedal pulses present with mild non-pitting edema bilaterally.
Neurological: No focal deficit.
1 What type of assessment would you perform during your head- to- toe assessment to check for diabetic neuropathy?
What diagnostic test would you order for this patient and why?
What treatment will you do at the office and what will you order
How will you monitor this patient,
When will you have the patient come back to see you
What education will you provide this patient
Any services at home?
Support your answers.
APA style
Case Study 5 Discussion
A 49 year old male with a history of hypertension and mixed hyperlipidemia presents to your primary care practice with abdominal pain. He states is started a “a few days ago” in the left lower quadrant of the abdomen and now feels as though it is spreading to the mid-abdomen. He describes the pain as coming suddenly, sharp and cramping in nature, constant, and becoming more intense. Last night he began having nausea and vomiting and has been constipated for the last 2 days. He also feels bloated. He has not taken his temperature at home however, has had chills and malaise. Denies rectal bleeding. The patient has decreased appetite, tolerating some liquids and bland foods.
Past Medical History:
Hypertension and Mixed Hyperlipidemia
Social History:
Nonsmoker; drinks a glass of wine daily with dinner, no illicit drugs
Vital signs:
BP 128/75, HR 99, 20 breath/min, temp 100.9 F.
Medications: Lisinopril 30 mg po daily; Rosuvastatin 20 mg po daily. No Known Allergies.
Physical exam:
General: Alert and oriented, appears stressed and anxious, ambulates into the practice examination room holding his abdomen.
HEENT: Normocephalic, atraumatic, white sclera. Mucus membranes are moist.
Cardiovascular (CV): Regular rate and rhythm, no murmurs, rubs, gallops, S1-S2 clear.
Pulmonary: clear to auscultation bilaterally
Abdomen: Moderate tenderness to palpation in the left lower quadrant and mild tenderness over mid abdomen without rebound, guarding, or rigidity. Bowel sounds are present throughout. Negative psoas and obturator signs; no distinct masses. Abdominal distention present.
Back: No cerebrovascular (CVA) tenderness
Neurological: No focal deficits
Skin: Warm and dry, no rashes
Answer the following questions:
What is you differential diagnosis?
What is your diagnosis?
What diagnostic tests should be ordered for this patient with rationale?
What type of medical treatment does the patient need? (Be specific)
What is the follow up required for this patient? (Be specific)
**Provide References**
Discussion 6 is attached in a pdf because there are x rays images. Please see attached.
