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

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 meâ€

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?