Please explain what she might have in detail and why. A 29-year old female comes
ID: 167029 • Letter: P
Question
Please explain what she might have in detail and why.
A 29-year old female comes for an office visit to her nurse practitioner because she feels jittery, anxious, and easily sweating, especially in her palms since a while ago, probably more than 3 years ago. Her old friend that she has meet recently also said that she seems to have lost weight but her lower front neck seems bigger than normal people, which the patient dismiss it as something ridiculous. She claims she has been healthy all her life, and she is trying to eat healthy and exercise regularly by doing yoga at least once a week. She doesn’t smoke but she drinks alcohol socially with friends. She is happily married with one 4-year old healthy child. Her husband works in construction, while she is an administrative assistant at a local public school. She denied having heart palpitation, and her menstruation has been irregular as always since she got it the first time when she was 13 years old.
Physical exam:
Temperature: 37.6o Celsius (normal: 36.10-37.20)
Blood pressure: 120/75 mmHg (normal: 120/80 mmHg)
heart rate: 115 beat/minute, irregular (normal 60-100 x/minute)
respiratory rate: 20/minute (normal 12 – 20 x/minute)
A thin looking woman, that kept shifting her sitting positions.
There is a soft mass in her right and left lower neck, most likely her thyroid glands, both size 2x2x1 cm. No pain on palpation.
Her eyes protruding, most likely an exophthalmos.
Her palms are sweaty, but no tremors.
Heart: heart sounds irregular, no murmurs. Most likely an atrial fibrillation. No heart enlargement
Lung: clear on auscultation.
Other physical exam is normal.
EXAMPLEEEE:::----->
Jim has been diagnosed with diabetes type 1 for 3 years and he has taken insulin shots that he
manages it himself twice a day. The last time he did was 3 hours before admission to the ER. Family history: (fill this based on the story above, making any relevant family history if any)
None.
Possible diagnoses (Differential diagnoses): (write the order from the most likely to the least like
diagnoses)
Explanation of pathophysiology of each of the differential diagnoses: (explain the pathophysiology of the differential diagnoses you choose above in 3-5 paragraphs each, along with the reason you think this patient fit your diagnoses)
1. Diabetic ketoacidosis (DKA) pathophysiology: 3 – 5 paragraphs. In this case, Jim’s DKA is probably exacerbated by a common cold or other upper respiratory tract infection.
Chief complaint: (fill this in based on the short history above): abdominal pain, nausea and vomiting
History of present illness: (fill this based on the story above, making summary of his current illness):
(how long does he has cough, fever, sneezing) He has cough, fever, and sneezing for 4 days
(how long does he has abdominal pain, nausea and vomiting) He complaints of abdominal pain,
nausea and vomiting since this afternoon
(what treatment he has taken for the current illness) He has taken Tylenol
History of past illness: (fill this based on the story above, making summary of his past/chronic illness):
Diabetic ketoacidosis (DKA)
Hyperglycemia
Hypoglycemia
Explanation / Answer
The following sufferer features a severe macrocytic anaemia in addition to neurological indicators because of nutritional B12 deficiency. You will find there's genealogy and family tree associated with hypothyroid disease. This can produce a macrocytic anaemia however not to this degree, in addition to thyroid problems would not make clear another features. Anaemia minimizes structure oxygenation and thus could affect a lot of wood systems. The indications in addition to warning signs of anaemia based upon its rapidity associated with onset. Chronic anaemia leads to tiredness in addition to pallor on the mucous membranes. Cardiorespiratory indications in addition to indicators involve breathlessness, chest pain, claudication, tachycardia, oedema and also other warning signs of heart failure. Digestive indications involve anorexia, weight reduction, and queasiness in addition to constipation. There could possibly be menstrual problems in addition to loss of libido. Nerve indications involve headaches, faintness in addition to cramps. Generally there could be a low-grade fever. In pernicious anaemia, the actual MCV might escalate to help 100–140fL, in addition to oblong macrocytes are located around the blood stream film. The reticulocyte count number is usually unnecessarily lower for the degree of anaemia. The white colored cellular count number will likely be somewhat reduced. Generally there can be a light improvement in serum bilirubin allowing the person any ‘lemon-yellow'complexion. Just as this sufferer, outstanding nutritional B12 deficit as well results in a side-line neuropathy in addition to subacute death on the rear articles in addition to pyramidal tracts from the vertebrae, creating a physical burning in addition to greater difficulty walking. The side-line neuropathy in addition to pyramidal area guidance make the amalgamation associated with missing ankle joint jerks in addition to upgoing plantars. Lot of intense style it can cause paraplegia, optic wither up in addition to dementia. Supplement B12 is usually produced by simply germs which are obtained by simply ingesting creature as well as veg products and solutions polluted by simply bacteria. Just after swallowing, it can be destined by simply inbuilt factor, produced by simply gastric parietal cellular material, and also this complex will be utilized from the critical ileum.