NR 511 Week 2 Part 1

Setting

Large urban city family practice clinic which employs physicians and nurse practitioners.

Today is another busy in your family practice clinic. You note your next visit is a work in for ear pain. The patients are a set of four year old twins. The entire family has been coming to the clinic for years which is probably why they were worked in despite your full schedule. You review the chart before entering the room to familiarize yourself with these patients.

When you enter the room you note a Caucasian woman who appears to be about 40 years old. She is well groomed and appropriately dressed for the weather. There are also two boys who appear to be about 4 years old who are sitting on the exam table playing games on their tablets and chatting to each other.

You introduce yourself as you always do and ask what brings them to the clinic today.

The mother states “Tommy woke up in the middle of the night saying his ear hurt so badly it woke him up. He says it hurts to touch. Paddy has had a cold for a few and been talking about his ears popping and feeling stuffy. I thought it was just the cold. He woke up this morning and said his ear really hurts too. He also feels warm to me”

HPI

Mom describes the boys as overall healthy and active 4-year-old children. Their older sister just got over a cold. The rest of the family has been well but Mom noticed she has a sore throat this morning and asks if you can look at her too as long as they are here. Her throat has hurt since yesterday, and hurts worse when she swallows. She has not eaten or drank anything because it hurts too much.

PMH

Paddy: age 4. Full-term pregnancy, NSVD twin gestation 5 pounds 2 ounces. No hospitalizations. NKDA. Daily medication – chewable children’s multivitamin with iron.

Tommy: age 4. Full-term pregnancy, NSVD twin gestation 5 pounds 4 ounces. No hospitalizations. NKDA. Daily medication – chewable children’s multivitamin with iron.

Mary (mom): denied past illness or injuries. Hospitalized x 2 for childbirth, no surgeries. NKDA. Drinks alcohol socially, denies tobacco or illicit drug use. Sleeps 6-7 hours/night. No current medications. Takes a daily multivitamin and a B complex vitamin.

Social

Paddy and Tommy live with both their parents, Mary and Patrick, and two older siblings. They are in a half day K4 program and Mom states they are doing well and like going to school. Mary’s parents also live with the family and care for the children after school. They have 2 dogs and a cat. Patrick and Mary’s father John Foley both smoke, but not in the house.

Discussion Part One (Please answer the questions separately for each patient)

• What further questions do you have forMary at this visit?
• Use OLDCARTS to guide your questions. Link the questions to your differential diagnoses.
• What is your differential diagnosis list for this visit thus far with rationale? Each differential diagnosis should include a one sentence pathophysiology statement supported by the scholarly literature or the textbook. Link the patient’s presenting symptoms with your differential diagnoses along with rationale.
• Based on your differential diagnoses list, what focused PE would you perform? What labs or diagnostic tests, if any, would you order?

• What further questions do you have forPaddy at this visit??
• Use your OLDCARTS to guide your questions. Link the questions to your differential diagnoses.
• What is your differential diagnosis list for this visit thus far with rationale?
• Each differential diagnosis should include a one sentence pathophysiology statement supported by the scholarly literature or the textbook. Link the patient’s presenting symptoms with your differential diagnoses along with rationale.
• Based on your differential diagnoses list, what focused PE would you perform? What labs or diagnostic tests, if any, would you order?

• What further questions do you have forTommy at this visit??
• Use your OLDCARTS to guide your questions. Link the questions to your differential diagnoses.
• What is your differential diagnosis list for this visit thus far with rationale? Each differential diagnosis should include a one sentence pathophysiology statement supported by the scholarly literature or the textbook. Link the patient’s presenting symptoms with your differential diagnoses along with rationale.
• Based on your differential diagnoses list, what focused PE would you perform? What labs or diagnostic tests, if any, would you order?

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