Week 2 Discussion.
Apply information from the Aquifer virtual case studies to answer the following questions:
- What is the Chief complain in the case studies? What are important questions to ask the patients to formulate the history of present illness and what did the patients tell you?
- What components of the physical exams are important to review in the cases? What are pertinent positive and negative physical exam findings to help you formulate your diagnosis?
- Which differential diagnosis is to be considered with each case study? What was your final diagnosis?
Answer the same questions for case study 1 and 2
Provide references
Do 2 pages.
South University College of Nursing and Public Health Graduate Online
Nursing Program
Aquifer Internal Medicine
Internal Medicine 15: 50- year-old male with cough and nasal congestion
Author/Editor:Author/Editor: Jennifer Bierman, MD
INTRODUCTION HISTORY
You speak with Dr. Griffin about Mr. Taleb.You speak with Dr. Griffin about Mr. Taleb.
!
It is September and you are working with Dr. Erin Griffin in her outpatient general medicine clinic. She asks you to see Mr. Fadil Taleb, a 50-year-old male with respiratory symptoms. Dr. Griffin tells you he is relatively new to the practice and has been seen only once in the past for a general physical.
HISTORY HISTORY
You begin to take a history from Mr. Taleb.You begin to take a history from Mr. Taleb.
!
You enter the room and introduce yourself. You then begin taking a history.
“What brings you to the oGce today”What brings you to the oGce today?”
“I have been sick for the past three or four days. It started with my throat being scratchy and lots of sneezing. Now my nose is all stopped up, and I’m blowing it constantly. I’m also coughing a lot.”
“Have you had a fever?””Have you had a fever?”
“I felt warm the first day but now I just have the chills occasionally. I am also really tired.”
The best options are indicated below. Your selections are indicated by the shaded boxes.
“Is anyone else you know ill?””Is anyone else you know ill?”
“My kids were sick at the end of last week. One of them is still coughing but the others seem better. My kids are in school right now, and during the school year it seems like one of them picks up something at school almost every other week. I ride the bus to and from work, and there are always people coughing there.”
“Do you smoke?””Do you smoke?”
“Yeah, doc, I know it’s not good for my health, but I do smoke. Usually it’s about a half pack per day, but since I have been sick, I have been smoking only one or two cigarettes a day.”
Question What risk factors does the patient have for an upper respiratory infection (URI)? Select all that apply.
A. Exposure to sick contacts, especially children in the
home
B. Cigarette smoking
C. Season
SUBMITSUBMIT
Answer Comment > The correct answers are A, B, C> The correct answers are A, B, C
Risk Factors for Upper Respiratory Infection Adults with children in their homesAdults with children in their homes have more frequent URIs (colds). American adults average two to four colds per year while children average six to eight. Crowded conditions predispose
TEACHING POINTTEACHING POINT
patients to infection; thus, the incidence of colds is higher in those who spend time in schools.
Studies have shown that cigarette smokecigarette smoke causes structural changes in the respiratory tract and diminishes the immune response to both bacterial and viral respiratory infections. Also, smokers have more severe symptoms when they have an URI.
There is a seasonal incidence of viral URIseasonal incidence of viral URI correlating with colder months in temperate areas. They begin in early fall and continue through the spring. Humidity probably plays a role with virus survival.
References
Archavi L, Benowitz NL. Cigarette Smoking and Infection. Arch Intern Med. 2004;164:2206-2216.
Gwaltney JM. “The Common Cold.” Principles and Practices of Infectious Diseases. 6th ed. St. Louis, MO: Churchill Livingston; 2005.
ROS AND CHART REVIEW HISTORY
You continue your history with Mr. Taleb.You continue your history with Mr. Taleb.
!
“Tell me more about your cough. Do you bring anything up?”
“No, it’s a dry cough, but it wakes me up at night several times.”
“Do you feel short of breath?”
“No, not really.”
“Does your chest hurt?”
“No. Can’t say that it does.”
“Have you tried any medicine to help?”
“My face has felt full, so I took some Actifed Cold and Allergy tablets, but they didn’t seem to do much. I’ve also taken some Cold-EEZE, vitamin C, and Waltussin DM, but nothing is helping.”
“Have you had problems like this before?”
“I had this same thing last fall and it lasted a couple of weeks. I hate to bother you doctors with this, but I don’t want to get any worse.”
You review Mr. Taleb’s chart and confirm the following:
Past Medical History:Past Medical History:
Hyperlipidemia (6 months ago)
Lab Values:Lab Values: Conventional:Conventional: SI:SI:
Total cholesterol 220 mg/dL 5.70 mmol/L
HDL 41 mg/dL 1.06 mmol/L
LDL 145 mg/dL 3.76 mmol/L
Medications:Medications:
None except over-the-counter medications Actifed Cold and Allergy (phenylephrine and chlorpheniramine) Cold-EEZE (zinc gluconate) Vitamin C Waltussin DM (guaifenesin and dextromethorphan).
AllergiesAllergies:
None
Family History:Family History:
Mother: Alive and well. Father: High cholesterol, HTN. Paternal uncle: Coronary artery disease, hx of MI. Three sisters: Well.
Social History:Social History:
Married and monogamous. Works as a computer specialist for the help desk at the hospital. Three children ages 12, 15, and 18 years old. Has smoked half pack per day for the past 25 years. Quit with each of his wife’s pregnancies, then resumed a year or so later. He rarely drinks alcohol and has never used IV drugs.
Review of Systems:Review of Systems:
No headache, myalgias, hemoptysis, weight loss, or night sweats.
See the associated reference ranges in conventional and SI units.
SUMMARY STATEMENT CLINICAL REASONING
Question Based on what you know about the patient so far, write a one- to three- sentence summary statement to communicate your understanding of the patient to other providers.
Guidel ines for summary statements.Guidel ines for summary statements.
Your response is recorded in your student case report.
Letter Count: 0/1000
SUBMITSUBMIT
Answer Comment Mr. Taleb is a 50-year-old male with a history of tobacco use who has a several day history of sore throat, nasal congestion, and non- productive cough which awakens him at night. He denies chest pain, myalgias, hemoptysis, weight loss or dyspnea.
The ideal summary statement concisely highlights the most pertinent features without omitting any significant points. The summary statement above includes:
1. Epidemiology and risk factors: 50-year-old male with a history of tobacco use. 2. Key clinical findings about the present illness using qualifying adjectives and transformative language:
rhinitis sore throat non-productive cough present at night lack of chest pain, myalgias, weight loss, hemoptysis or dyspnea.
The best options are indicated below. Your selections are indicated by the shaded boxes.
DIFFERENTIAL DIAGNOSIS 1 CLINICAL REASONING
Question Based on Mr. Taleb’s history, which of the following are the top threethree diagnoses on your differential? Select all that apply.
A. Allergic rhinitis
B. Acute bacterial sinusitis
C. Acute bronchitis
D. Asthma
E. Bacterial pneumonia
F. Influenza
G. Strep pharyngitis
H. Tuberculosis
I. Viral upper respiratory infection
J. Infectious mononucleosis
K. Pertussis
SUBMITSUBMIT
Answer Comment > The correct answers are A, C, I> The correct answers are A, C, I
Most Likely / Important DiagnosesMost Likely / Important Diagnoses
The following are the most likely / important diagnoses at this point:
allergic rhinitis (A)allergic rhinitis (A) acute bronchitis (C)acute bronchitis (C) viral upper respiratory infection (URI) (I)viral upper respiratory infection (URI) (I)
DiUerential of Acute Respiratory Symptoms in Middle- Aged Male with Tobacco History The following diagnoses are less likely:The following diagnoses are less likely:
Acute bacterial sinusitisAcute bacterial sinusitis
Occurs when an initial viral nasopharyngeal infection spreads to become a secondary bacterial infection of the paranasal sinuses.
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