06 Feb He is a graduate student at the univ

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 4 Discussion

Diagnostic Reasoning and Advanced Physical Assessment

Module 4 Case Study

K.H. is a 16 year old male who presents to your exam room with recurrent episodes of dyspnea. His mother is with him and reports he has been in his usual good health until this past fall football season ( 4 months ago), when she noticed him wheezing after activities. Usually the wheezing would resolve spontaneously after a couple of minutes of rest. When you ask K.H. how often he feels SOB, he states it has gotten worse and now even walking up a flight of steps causes wheezing and coughing. He also admits to increased fatigue with decreased exercise tolerance.

PMH: Croup as an infant. Recurrent URIs as a child. Immunizations are Up To Date.

Surgical History includes PE tubes at age 3 for chronic OTM (Otitis Media)

Medications: None Allergies: Amoxicillin (hives)

SH: Breast fed x 6 month. Normal Developmental Milestones. Currently in grade 10 at local high school. Active in sports (football, baseball) Grades: As and Bs. + Smoking 3-4 cigs per day x 1 year. Neg for ETOH (alcohol)

Denies illegal drugs. Lives at home with both parents and sister

FH: Mother living @ age 36 with Hypertension and Hypothyroidism – Asthma, – Pneumonia – Smoking

Father living @ age 40 with GERDS -Asthma -Pneumonia + Smoking 1 ppd x 10 years

Siblings: 1 Sister age 13 with recurrent URIs

MSN610 Diagnostic Reasoning and Advanced Physical Assessment

Module 5 Discussion

Case Study 5

CC: J.D. is a 32 year old male presents to your office for a complete physical exam as a new patient. He c/o intermittent episodes of diarrhea, abdominal discomfort, bloating and occasional constipation.

HPI: J.D. states he often eats a meal and within 10 minutes, he feels bloated and “gassy”. He frequently has periods of nausea, urgent watery diarrhea. This is embarrassing for him as he is not always near a bathroom. This has become progressively worse over the last years and occurs almost daily. He first realized he was having bowel problems when he was in high school when he played on the football team. Diarrhea always seemed to get worse on game day. He denies vomiting or laxative use.

PMH: No hospitalizations or surgeries. His childhood immunizations were all completed and he had a tetanus booster 5 years ago. Only health problem has been his abdominal bloating and “bowel problems”. He was treated for strep throat and a sinus infection 5 years ago with Amoxicillin.

FH: Relationship Mortality Age Health Problems

Mother Alive 54 None

Father Alive 56 Arthritis

MGM Alive 70 HTN, Rheumatoid Arthritis, HLN

PGM Alive 66 Breast CA, Pacemaker

PGF Alive 67 None

MGF Deceased 65 CVA

SH: He is a graduate student at the university studying Psychology. He lives in an apartment with his girlfriend.

He drank heavily in high school, but may have 1 glass of wine weekly. Denies smoking cigs/marijuana or IV drug use. He exercises regularly but his diet is “awful” and depends on how hectic his