I need help with a Health & Medical question. All explanations and answers will be used to help me learn.
Female Genitourinary, & Musculoskeletal
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 1Case 2Case 3Chief Complaint
(CC) “I have a tumor on my left breast”“I have pain during intercourse and urination”“My back hurts so bad I can barely walk”History of Present Illness (HPI)A 55-year-old African American social worker presents to your clinic with a finding of a lump in her left breast while in the shower this past week.A 19-year-old female reports to you that she has “sores” on and in her vagina for the last three months.A 35-year-old male painter presents to your clinic with the complaint of low back pain. He recalls lifting a 5-gallon paint can and felt an immediate pull in the lower right side of his back. This happened 2 days ago and he had the weekend to rest, but after taking Motrin and using heat, he has not seen any improvement. His pain is sharp, stabbing, and he scored it as a 9 on a scale of 0 to 10.Drug HxI took birth control pills for 10 years, starting when I was 20 I am not on hormone replacementShe tries to practice safe sex but has a steady boyfriend and figures she doesn’t need to be so careful since she is on the birth control pill Motrin for pain.Family HxMy grandmother had breast cancer when she was 76 years old Father hypertension
Mother DM
Subjective
Denies any fever or chills. No changes in vision or hearing, no difficulty chewing or swallowing. Supple neck, states that she does self-breast-exams on occasion. Menopause at 52
No skin changes or nipple discharge from the left breast
states “I have sores and bumps on the inner creases of my thighs and pelvic area”. “There is yellowish discharge from the sores that comes and goes”He is having some right leg pain but no bowel or bladder changes. No numbness or tinglingObjective Data VStemperature 98.6°F; respiratory rate (RR) 16; heart rate (HR) 80, regular; blood pressure (BP) 130/84; height: 5?8?; weight 160 lbs; body mass index (BMI) 24temperature: 100.2°F; pulse 92; respirations 18; BP 122/78; weight 156 lbs, 25 lbs overweight; height 5?3?temperature: 98.2°F, respiratory rate 16, heart rate 90, blood pressure 120/60
O2 saturation 98%
Generalwell developed, nourished, healthy-appearing femalepatient appears to have good hygiene; minimal makeup, pierced ears, no tattoos; well nourished (slightly overweight); no obvious distress notedwell-developed healthy 35-year-old male; no gross deformities HEENTAtraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear, nares patent, nasopharynx clear, edentulous.
Atraumatic, normocephalic, PERRLA, EOMI, conjunctiva and sclera clear; nares patent, nasopharynx clear, good dentition. Piercing in her right nostril and lower lip.
Atraumatic, normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent, nasopharynx clear, poor dentition – multiple carries.Lungsclear to auscultation
within normal limits, appropriate lung sounds auscultated, clear and equal bilaterally
CTA AP&LCardregular rate and rhythm (RRR)S1S2 without rub or gallopS1S2 without rub or gallopBreastExamined in sitting and supine positions. In sitting position, no evidence of skin changes, right breast is slightly larger than the left, symmetrical movement with the arms above the head and at the side and with flexion of the pectoral muscles; 5-mm nonmobile, non-tender, firm mass felt at 10 o’clock position, 5 cm from the areola. Right breast without dominant masses or tenderness. Nipples without inversion or evidence of nipple discharge. Breast mass is palpated in the supine position in the same manner as in the sitting position
INSPECTION: no dimpling or abnormalities noted upon inspection
• PALPATION: Left breast no abnormalities noted. Right breast: denies tenderness, pain, no abnormalities noted.
INSPECTION: no dimpling or abnormalities noted upon inspection
PALPATION: Left breast – no abnormalities noted. Right breast – denies tenderness, pain, no abnormalities noted.
Lymphnegative axillary, infraclavicular, and supraclavicular lymphadenopathyInguinal Lymph nodes: tenderness bilaterally, numerous, 1 cm in sizeno bruising, fever, or swelling noted, no acute bleeding or trauma to skin.Abdnormoactive bowel sounds x 4;tender during palpation; the left lower quadrant was very tender during palpation; patient denies nausea or vomitingbenign, normoactive bowel sounds x 4; Hepatomegaly 2cm below the costal margin.GUBladder is non-distended.labia major and minor: numerous ulcerations, too many to count; some ulcerations enter the vaginal introitus; no ulcerations in the vagina mucosa; cervix is clear, some greenish discharge; bimanual exam reveals tenderness in left lower quadrant; able to palpate the left ovary; unable to palpate the right ovary; no tenderness; uterus is normal in size, slight tenderness with cervical mobilityBladder is non-distended.Integumentgood skin turgor noted, moist mucous membranesintact without lesions masses or rashes.MSMuscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.Muscles are smooth, firm, symmetrical. Full ROM. No pain or tenderness on palpation.No obvious deformities, masses, or discoloration. Palpable pain noted at the right lower lumbar region. No palpable spasms. ROM limited to forward bending 10 inches from floor; able to bend side to side but had difficulty twisting and going into extension. NeuroNo obvious deformities, CN grossly intact II-XIINo obvious deficits and CN grossly intact II-XIIDTRs 2+ lower sensory neurology intact to light touch and patient able to toe and heel walk. Gait was stable and no limping noted.
Once you received your case number, 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.
What teachings will you provide?
Expert Solution Preview
Introduction:
As a medical professor, I am responsible for creating assignments and evaluating the performance of medical college students. This discussion involves a case scenario in the fields of Female Genitourinary and Musculoskeletal health. The case focuses on three different patients presenting with unique chief complaints and medical backgrounds. In this response, I will address the questions provided in the content.
Answer to question 1:
To obtain additional subjective data, I would ask the patient about the duration and frequency of their symptoms. It is important to inquire about any associated symptoms, such as fever, weight loss, or changes in appetite. I would also ask about any history of similar symptoms in the past and any relevant personal or family medical history. Additionally, obtaining information about the impact of the symptoms on the patient’s daily activities and quality of life would be valuable.
Answer to question 2:
In addition to the objective findings already mentioned in the case scenario, I would perform a thorough physical examination. For the patient with the breast tumor, I would palpate the lymph nodes in the axilla and supraclavicular areas to check for any signs of metastasis. In the case of the patient with pain during intercourse and urination, a pelvic examination would be necessary to evaluate the vaginal and cervical areas. For the patient with back pain, a detailed musculoskeletal examination would be conducted to assess the range of motion, muscle strength, and presence of any deformities or abnormalities.
Answer to question 3:
Based on the patient’s clinical presentation, there are several diagnostic exams that I would consider ordering. For the patient with a breast tumor, a mammogram and/or ultrasound could be ordered to further evaluate the mass and determine if it is benign or malignant. In the case of the patient with vaginal sores and discharge, a swab or culture of the lesions could be taken to identify any potential infectious agents. For the patient with back pain, imaging studies such as X-rays or an MRI may be ordered to assess the spinal structures and identify any disc herniation or other abnormalities.
Answer to question 4:
Three differential diagnoses for the patient presenting with a breast tumor could include:
1. Breast cancer: Given the patient’s age, the presence of a mass, and family history of breast cancer, malignancy should be considered.
2. Fibroadenoma: This is a benign breast tumor commonly seen in women of reproductive age. The characteristics of the mass, such as being nonmobile, may indicate a fibroadenoma.
3. Cyst: A fluid-filled sac in the breast may present as a lump. Cysts are commonly seen in premenopausal women and are usually benign.
Answer to question 5:
Rationale for each differential diagnosis:
1. Breast cancer: The patient’s age, finding of a lump, and family history of breast cancer increase the suspicion for malignancy. Further diagnostic exams, such as a mammogram or biopsy, would be needed to confirm or rule out this diagnosis.
2. Fibroadenoma: The characteristics of a nonmobile, non-tender, firm mass at a relatively young age suggest a benign fibroadenoma. However, additional imaging and physical examination findings would be required to support this diagnosis.
3. Cyst: The presence of a fluid-filled mass in the breast, along with the possible hormonal influence in a premenopausal woman, is consistent with a cyst. Aspiration or imaging-guided biopsy may be required for confirmation.
Answer to question 6:
In terms of teaching, I would start by providing information on breast self-examination and emphasizing its importance for early detection of breast abnormalities. I would educate the patient about the signs and symptoms of breast cancer and encourage regular mammography screenings, especially for those with a family history. For the patient with vaginal sores and discharge, I would stress the importance of safe sex practices, including the use of barrier methods, and the value of regular gynecologic examinations. In the case of the patient with back pain, I would focus on proper body mechanics, lifting techniques, and the importance of regular exercise for maintaining a healthy musculoskeletal system. Additionally, I would provide recommendations for pain management, including the use of heat or ice therapy, over-the-counter pain medications, and when to seek further medical attention.
