You review the chart before entering the room. The patient
You review the chart before entering the room. The patient is Elizabeth, age 16, with a chief complaint of a left ankle injury. Elizabeth is an Irish dancer and has been seen in the past for other injuries. At the last visit 8 months ago, Elizabeth had a groin pull and was sent to physical therapy (PT) for evaluation and treatment. The PT notes state Elizabeth has lax ligaments and responded well to PT. She was released to return to dance without restrictions 3 weeks ago.HPI: Elizabeth presents with her mother. You note Elizabeth is on the exam table with her legs resting on the table. Her left ankle is wrapped in an ace bandage. A pair of crutches is resting against the wall. You introduce yourself as the student NP and tell the patient and her mother you are starting the exam, but your preceptor will be in as well to examine and evaluate her. Elizabeth states that during dance class last night she “landed on the side of my ankle and I heard a pop. The dancers across the room heard the pop too.” Elizabeth was unable to bear weight and had to be carried to the car. Last night Mom iced the ankle and came here first thing in the morning.When Elizabeth tries to bear weight, her left ankle gives away, and she is unable to walk unassisted. Mom did not want to go to the ER last night. She asks if she did the right thing by waiting until the morning to get Elizabeth evaluated.PMHx: Reports general health as good. No serious health issues. She had previous ankle and groin injuries related to dance.High school student in 10th grade gets good grades. She has been an Irish dance for 8 years and has dance class twice a week.What would be differential diagnosis?Did her mom do the right thing by waiting until this morning or should she have taken her to ED last night?
I am going to have to PING louder..needed you earlier...If I
I am going to have to PING louder..needed you earlier...If I didn't feel uncomfortable this might be funny..or not. Ok woke you about 2 am with terrible gas pains (the kind that double you over) Tried hot shower, hot bath, hot water bottle heating pad. Then thought what about an enema..sounds simple enough...water in..water and gas out...Yeah no...got some gas out put still nothing else. It's been hours...thought earlier I was getting somewhere but things have slowed down. Can't think this is serious..my colon hasn't seen much liquid in weeks...So bottom (no pun intended) this is a wait out thing and not an ER thing, right.Since couldn't find you yesterday missed telling you some good news..I seldom do that. No nausea, actually WANTED a sandwich and after a couple of rough am hours...didn't think of dying the rest of the day ! Thoughts drifting through today but think it's because I don't feel so well. Also noted...after being mostly immobile and eating and drinking next to nothing for almost 8 weeks ..when you go out that first day...you are way weaker than you expected.
I have been having increasingly bad pelvic/leg pain and also
I have been having increasingly bad pelvic/leg pain and also slightly nauseous. Now the nausea is getting worse.JA: What seems to make the symptoms worse or better? Any redness or swelling in the leg?Customer: No red or swollen areas. It's been bothering me for weeks on and off but now has become quite persistent and the nausea as well.JA: Anything else in your medical history you think the doctor should know?Customer: Not that I can think of
FCPS (R) General Surgery
I have been having abdominal pain, nausea, diarrhea, and
I have been having abdominal pain, nausea, diarrhea, and fatigue since June 13. I have been in the hospital twice this month due to dehydration and not eating. On 8/26 I had a Colonoscopy and this is the pathology report from that. Is this of concern?FINAL PATHOLOGIC DIAGNOSIS:A. COLON POLYPECTOMY, RIGHT:Fragments of tubular adenoma.B. COLON BIOPSY, RIGHT/TRANSVERSE:Architecturally preserved colonic mucosa with a few foci of cryptitis, (seenote).Note: The pathologic changes are mild, and the possible etiologies includeself-limiting infectious colitis, drug injury (NSAIDs), an early stage ofischemia or inflammatory bowel disease. No diagnostic features of lymphocyticor collagenous colitis seen.**Electronically Signed Out By Mari Mino-Kenudson MD**
Recent ALT of 74. AST 68. Been taking 20mg of Revatio for 2
Recent ALT of 74. AST 68. Been taking 20mg of Revatio for 2 years. Possible cause . Ultrasound next week.JA: What medications do you take daily? Are you allergic to any medications?Customer: Oxycodone 10-325 once a day/ morning. Sometimes drink in late afternoon.JA: Anything else in your medical history you think the doctor should know?Customer: Had prostrate cancer 2 years back. That's the time I started Revatio.
Pre diabetic" for 8 years with A1C ranging from 5.9-6.3
Pre diabetic" for 8 years with A1C ranging from 5.9-6.3 while normal weight and slightly overweight. Diagnosed with GDM during spontaneous twin pregnancy that failed diet and oral hypoglycemics thus requiring insulin. A1C has been between 6.5-7.5 post pregnancy (3 years next month). Took metformin and saw no change in blood sugars at home, despite diet and exercise, but have had regular cycles ever since. Stopped metformin for 54 months and had free testosterone of 6.3, total testosterone 42 and SHBG 38. Most recent labs had fasting glucose 149, fasting insulin 11.7Prior to pregnancy, had oligomenorrhea - longest cycle 93 days. TSH 5 and started on Synthroid. Weaned off during pregnancy and TSH normal ever since.My question is, with a history of elevated sugars even at normal weights and now with a normal insulin level simulateous to an elevated glucose, would you consider LADA in differential diagnosis? PCOS was suspected dt oligomenorrhea, weight gain, and elevated sugars but now with normal insulin level would this still be considered as well? I feel like it is assumed that because I am overweight I have type 2 diabetes but I just feel like there is something more than that going on.
Lily 16 years old, Riley 24 month old male have had several
Lily 16 years old, Riley 24 month old malehave had several episodes of vomiting over the last 2 days and have developed diarrhea in the last 24 hours. Lilly has not vomited today, but Riley vomited twice this morning in small amounts since awakening. They have both had low-grade fevers of around 100 to 101 degrees in the afternoons. Mother reports that both have not eaten solid food since 36 hours prior to this visit, when they went to a pizza buffet in a town nearby. They have been keeping down some sprite, apple juice, and popsicles. Both urinated this morning. Mother has given both children Pepto-Bismol over the counter (OTC) to prevent an upset stomach and acetaminophen two to three times a day for fever, but she reports that Riley vomited soon after his dose this morning. Lilly is complaining of some lower abdominal pain starting this morning, but also reports she has started menses today. Lilly complains also of headache, myalgia. Her pain is a 5 on a 1-10 scale and has progressed in the last hour. No other household members are ill.what are the differential diagnosis at this point?What further OLDCART and ROS information is important today specific to their chief complaints?