Sentinel U APS Tomas Velasco Case| 2026 Update with complete solutions – Post University.

Sentinel U APS Tomas Velasco Case| 2026 Update with complete solutions – Post
University.

Patient Profile

 Age: 67 years
 Sex: Male
 Ethnicity: Hispanic
 Simulation Area: Oncology
 Chief Complaints:
o Confusion
o Back Pain

Key Assessment Priorities

History Questions

 Onset and duration of confusion
 Severity and location of back pain
 Recent weight loss
 Fatigue
 Cough
 Hemoptysis
 Shortness of breath
 Smoking history
 Cancer history
 Medication history
 Recent infections
 Family history of malignancy

Physical Examination

 Vital signs
 Mental status assessment
 Neurologic examination
 Respiratory examination
 Musculoskeletal/spinal assessment
 Lymph node assessment
 General cancer screening indicators

Differential Diagnoses

1. Metastatic lung cancer with spinal metastasis
2. Hypercalcemia of malignancy
3. Brain metastases causing altered mental status
4. Multiple myeloma

, 5. Spinal cord compression
6. Metastatic prostate cancer
7. Infection/sepsis
8. Electrolyte abnormalities

Important Diagnostic Tests

Laboratory Studies

 CBC
 CMP
 Calcium level
 Magnesium
 Phosphorus
 Liver function tests
 Renal function tests
 PSA (if indicated)
 ESR/CRP

Imaging

 Chest X-ray
 CT Chest
 MRI Spine
 CT/MRI Brain
 PET Scan (oncology workup)

Common Pathophysiology Focus

A typical learning objective in a patient presenting with confusion and back pain is recognizing:

Hypercalcemia of Malignancy

Expected findings:

 Confusion
 Weakness
 Fatigue
 Constipation
 Bone pain
 Dehydration

Mechanism:

 Tumor secretion of PTH-related peptide
 Osteolytic bone metastases