For this Discussion, you will take on the role of a clinician who is building a health history for one of the following cases. Your instructor will assign you your case number.
| Case 3 | |||
| Chief Complaint (CC) |
“neck swelling” | ||
| History of Present Illness (HPI | s | A 42-year-old African American female who refers that she has been noticing slow and progressive swelling on her neck for about a year. Also she stated she has lost weight without any food restriction | |
| PMH | Patient denies | ||
| PSH | Surgical removal of benign left breast nodule 2 years ago | ||
| Drug Hx |
No medication at the time | ||
| Allergies | NKA | ||
| Subjective | Mild difficult to shallow, Neck feels tight, Pt states she feels Palpitations | ||
| Objective Data | |||
|---|---|---|---|
| PE | B/P 158/90; Pulse 102; RR 20; Temp 99.2; Ht 5,4; wt 114; BMI 19.6 | ||
| General | 42-year-old female appears thin. She is anxious – pacing in the room and fidgeting, but in no acute distress. | ||
| HEENT | Bulging eyes | ||
| Neck | Diffuse enlargement of the thyroid gland | ||
| Lungs | CTA AP&L | ||
| Card | S1S2 without rub, Tachycardia | ||
| Abd |
|
benign, normoactive bowel sounds x 4 | |
| GU | Non contributory | ||
| Ext | no cyanosis, clubbing or edema | ||
| Integument | Thin skin, Increase moisture | ||
| Neuro | No obvious deficits and CN grossly intact II-XIIa |
answer the following questions:
- What other subjective data would you obtain?
- What other objective findings would you look for?
- What diagnostic exams do you want to order?
- Name 3 differential diagnoses based on this patient presenting symptoms?
- Give rationales for your each differential diagnosis.
Submission Instructions:
- Your initial post should be at least 550 words, formatted and cited in current APA style with support from at least 2 academic sources.
- You should respond to at least two of your peers by extending, refuting/correcting, or adding additional nuance to their posts. Your reply posts are worth 2 points (1 point per response.)
- All replies must be constructive and use literature where possible.
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