Week 1 Discussion Health Assessment PHYSICAL EXAM
Week 1 Discussion Health Assessment PHYSICAL EXAM
1b) Explain your rationale for asking these two additional questions.
1c) Describe what the two (2) additional questions might reveal about the patient’s health.
DOMAIN: PHYSICAL EXAMM
For each system examin in this case;
2a) Explain the reason the provider examin each system.
2b) Describe how the examM findings would be abnormal based on the information in this case. If it is a wellness visit, based on the patient’s age, describe what examM findings could be abnormal.
2c) Describe the normal findings for each system.
2d) Identify the various diagnostic instruments you would need to use to examin this patient.
DOMAIN: ASSESSMENT (Medical Diagnosis)
Discuss the pathophysiology of the:
3a) Diagnosis and,
3b) Each Differential Diagnosis
3c) If it is a Wellness, type ‘Not Applicable’
DOMAIN: LABORATORY & DIAGNOSTIC TESTS
Discuss the following:
4a) What labs should be ordered in the case?
4b) Discuss what lab results would be abnormal.
4c) Discuss what the abnormal lab values indicate.
4d) Discuss what diagnostic procedures you might want to order based on the medical diagnosis.
4e) If this is a wellness visit, discuss what the U.S. Preventive Taskforce recommends for patients in this age group.
PLEASE USE APA REFERENCES NO LONGER THEN 5 YEARS OLD. CASE STUDY IS ATTACHED PLEASE READ THROUGH ALL OF IT BEFORE ANSWERING THE QUESTIONS ABOVE.
ORDER CUSTOM, PLAGIARISM-FREE PAPER
You are working with Dr. Stephanie Lee at her family medicine clinic. Dr. Lee tells you, “The next patient, Mrs. Payne, is a 45-year-old cisgender female who is here for a health maintenance exam. It looks like she hasn’t had a visit for over five years. When you’re talking with Mrs. Payne, I’d like you to find out if she has any current concerns, update her past medical history, and do a brief review of systems. Then, come on out and tell me what you’ve discovered and we’ll both go in to do the physical exam together.”
You introduce yourself to Mrs. Payne and begin obtaining her history:
Medical History:
“Do you mind if I ask you a few questions to find out how you are doing?”
Mrs. Payne says, “That sounds fine.”
“What brought you in today?”
“I feel fine, but I know I should get checked out since it’s been a while and I need to have a Pap test and mammogram.”
“I would like to update your medical history. Do you have any chronic medical problems?”
“Well, I don’t really have any medical problems.”
“Have you had any operations?”
“I had my tubes tied shortly after the birth of my last child.”
“Are you on any medications, or are you allergic to any medications?”
“I take an occasional Tylenol or ibuprofen for pain or headache and a multivitamin. I’m not allergic to any medicine as far as I know.”
Social History:
“Have you ever smoked?”
“Yes, I’m afraid I do smoke a pack of cigarettes a week. I keep trying to quit, but I just never seem to be able to do it.” Week 1 Discussion Health Assessment PHYSICAL EXAM
“Do you drink alcohol?”
“No, I don’t drink any alcohol at all.”
“Have you ever used any recreational drugs?”
“I never tried any illegal drugs. My friends have smoked marijuana but I was always too afraid to try.”
“How much do you exercise?”
“I used to try to walk at lunchtime, but I don’t do that anymore. It just seems like I’ve been too busy to have time to exercise.”
“Have you been hit, kicked, punched, or otherwise hurt by someone in the past year? If so, by whom?”
“No, I feel safe.”
Family History:
“How is the health of your family members?”
“My father has high blood pressure and my mother has mild arthritis, but both are in good health. My two sisters are healthy.”
“What about your extended family?”
“I don’t know how my grandparents died, but I think one of them had diabetes. My mom’s sister has breast cancer but is doing well after surgery and chemotherapy.”
Mrs. Payne asks you, “Does having an aunt with breast cancer increase my risk of developing breast cancer? My aunt was diagnosed with breast cancer when she was about 70 years old.”
You were able to reassure Mrs. Payne that the risk is increased only if there is a history in a first-degree relative, such as a parent or sibling.
OB/GYN:
“How old were you when your periods began?”
“Around 13 or 14.”
“Are your periods usually regular?”
“They have always been regular until the last year, when my menstrual flow has decreased.”
“Can you describe what you mean?”
“My cycles have lengthened and the flow has decreased. I think I might be having hot flashes once in while, too. I’m wondering if I might be going through menopause.”
You tell Mrs. Payne you would like to address this issue in more detail when you return later with Dr. Lee.
“Have you ever had an abnormal Pap test?”
“I had one abnormal Pap test seven or eight years ago. Dr. Lee did a test and took some samples but everything turned out normal. I had another Pap test one year later that was normal. I then had another normal one a few years ago, right?”
“Right. You mentioned having a child. How many times have you been pregnant?”
“I have been pregnant three times, and I have three children.”
When you ask Mrs. Payne about health maintenance, she says she has never had a mammogram. She tells you, “One of the big reasons I’ve been putting off coming to see Dr. Lee is because I know she will recommend a mammogram. I think I should have one since my aunt had breast cancer and all, even though we just discussed how that shouldn’t increase my risk. But a friend of mine told me her mammogram was very painful. I have done breast self-exams, but not very often. I did notice some tenderness the last time I did my exam.”
You respond, “Let’s talk more about mammograms with Dr. Lee when she comes in. Are there any other issues you’d like to cover today?”
Mrs. Payne indicates that she’s discussed all her concerns with you already. You excuse yourself while Mrs. Payne changes into a gown for her physical exam.
After presenting Mrs. Payne’s history and vital signs to Dr. Lee, the two of you knock on the door and reenter the room. After greeting Mrs. Payne, Dr. Lee asks if she minds if you perform the physical examination with Dr. Lee observing. Mrs. Payne assents. Week 1 Discussion Health Assessment PHYSICAL EXAM