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NR 511 week 6 discussion 1

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1. Briefly and concisely summarize the H&P findings as if you were presenting it to your preceptor using the pertinent facts from the case. Use shorthand where possible and approved medical abbreviations. Avoid redundancy and irrelevant information. 1. Provide a differential diagnosis (minimum of 3) which might explain the patient's chief complaint along with a brief statement of pathophysiology for each. 2. Analyze the differential by using the pertinent findings from the history and physical to argue for or against a diagnosis. 3. Rank the differential in order of most likely to least likely. 4. Identify any additional tests and/or procedures that you feel is necessary or needed to help you narrow your differential. All testing decisions must be supported with an evidence-based medicine (EBM) argument as to why it is necessary or pertinent in this case. If no testing is indicated or needed, you must also support this decision with EBM evidence.

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NR 511 week 6 discussion 1


Differential Diagnosis & Primary Care Practicum (Chamberlain University)

, Hello Dr. and class,

1. Briefly and concisely summarize the H&P findings as if you were presenting it to
your preceptor using the pertinent facts from the case. Use shorthand where possible and
approved medical abbreviations. Avoid redundancy and irrelevant information.

Patient is a 56- year- old Caucasian female presenting to the office with complaint of

fatigue which began 2-3 months ago and has progressively gotten worse. She also complains

of symptoms getting worse with activity and reports that nothing has helped to decreased them.

She states that despite getting 8 hours of sleep nightly she constantly feels tired and has “no energy

to do anything I normally can do”. She also reports having missed a day of work because she

“couldn't get out of bed”. Pt states that fatigue is aggravated by exertion and that there are no

relieving factors. She has not tried any OTC or home remedies. Pt also reports that she has

had worsening depression and a 5-pound weight gain over the last six months.

Patient denies SI/HI. In addition, she reports that she has been having intermittent muscle

cramps in her calves. She denies fever, chills, SOB, CP, wheezing, cough, N/V/D, ear pain,

snoring, sleep apnea. Denies smoking. Negative for swelling, lymphadenopathy. Appropriate

mood, full strength throughout. Positive for constipation, cold intolerance, and dry skin. Patient's

medical history includes hypertension, depression, and she has been menopausal for 5 years. The

only surgical history is tonsillectomy during childhood. Her medications include: Multivitamin,

b-Complex, Prozac 20mg, Bisoprolol-HCTZ 2.5mg/6.25mg, calcium 500mg and Vit D3 400IU.


1. Provide a differential diagnosis (minimum of 3) which might explain the patient's
chief complaint along with a brief statement of pathophysiology for each.

Hypothvroidism (ICD10 E03 9)

Hypothyroidism is basically a decrease in thyroid function. Thyrotropin-releasing

hormone (TRH) is produced in the hypothalamus and stimulates the anterior pituitary to secrete

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