A 48-year-old Asian American woman is concerned about thin bones

Case 1

A 48-year-old Asian American woman is concerned about thin bones. Her mother was diagnosed with osteoporosis at the age of 50 and fell at the age of 68 and fractured her hip and spent months in Rehab before being able to return home. The patient has no history of fractures.  The patient presents to the office to have her bones checked to see if she has “thin bones” Patient has no history of previous fractures: Patient states she went through Menopause at the age of 43-44 with no major problems. Patient was diagnosed with hypothyroid at at age 40. Patient does not drink. Smokes 1ppd for 20 yrs. Husband has been out of work for 9 months due to downsizing at his job. Pt works as an administrative assistant for a publisher but does not have health insurance at this time.

Pt had a melanoma removed from her left cheek in 2018; No hospitalizations except for childbirth x2

Family history: Paternal Grandmother died at age 78 due to heart disease. Paternal Grandfather died at age 83 due to heart attack. Maternal Grandmother died at age 82 cause unknown; Maternal Grandfather died from farm accident at age of 56. Mother is 75 alive with Osteoporosis diagnosed at age 50 and HTN diagnosed at age 63. Father is 77 alive with HTN diagnosed at age 45. Pt has two daughters alive and well with no medical problems.

Objective Info

Height 5’2’ Wt 105 lbs; BMI 19.2; 128/78; HR-72/min

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HEENT: Normocephalic, no lumps/lesions

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Neck: supple without adenopathy , no thyromegaly.

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Lungs: Eupneic, CTA

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CV: RRR, no murmurs, rubs or extra sounds noted; 2+ peripheral pulses, no edema noted

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Breast: soft, fibrocystic changes bilaterally, without masses, dimpling or discharge

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Abd: soft, +BS, no tenderness

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MS: Full ROM in spine and shoulders. No tenderness, no spasms

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T-Score is -1.2

 

Case 4

A
32-year-old African American woman presents to the clinic for her 24-week check-up
. Pt states her morning sickness has resolved. However, she states she seems sad often and does not understand why, as she is happy about the pregnancy.

HPI: Pt is 24 weeks gestation. The patient is having sad moods at least once a day. She also states she is tired all the time, but figures that is just part of being pregnant, but has no energy and does not feel like doing her usual daily chores. She finds it difficult to go to work every day. This moodiness started about a week ago. She tried going to bed earlier but it did not seem to help. Taking 1 prenatal vitamin every day, No known drug, food, or environmental allergies. Family history is significant only for diet-controlled DM in paternal grandfather with onset in mid 40’s, Mother 58 yrs old is healthy; Father 60 yrs old with hx of DM with onset at age 45 and chronic depression which began in early 20s.

Objective Info

Height 5’4” Wt 147 lbs; BMI 25.2; 132/78 (sitting); HR-88/min

 

Case # (1, 2, 3 or 4) and Description of the Case Chosen:

 

Case 1

Case 2

Case 3

Case 4

 

 

 

Outline Subjective data.

 

Identify data provided in your chosen case and any additional data needed.

Outline

Objective findings.

 

Identify findings provided in your chosen case and any additional data needed.

Identify diagnostic tests, procedures, laboratory work indicated.

 

Describe the rationale for each test or intervention with supporting references.

Distinguish at least three differential diagnoses.

 

Describe the rationales for your choice of each diagnosis with supporting references.

Identify appropriate medications, treatments or other interventions associated with each differential diagnosis.

 

Describe rationales and supporting references for each.

 

Explain key

Social Determinants of Heath (SDoH) for your chosen case.

Describe collaborative care referrals and patient education needs for your chosen case.

 

Describe rationales and supporting references for each.