BIOD 151 MODULE 1 – MODULE 7 ALL EXAM ANSWER KEY IN ONE DOCUMENT

Jennifer Albertson Chief complaint: trouble sleeping HPI: Patient is a 65 year old female. Patient presents with complaints of trouble sleeping. Stared a couple months ago and was intermittent. Now it is multiple times a week. Patient has problems both falling asleep and staying asleep. Patient tosses and turns for 1-2 hours trying to go to sleep then wakes up at 2- 3AM and has trouble going back to sleep. Patient is a light sleeper and awakes with noise. ROS: Constitutional: Patient reports feelings of nervousness. Denies depression, anxiety. Increase in weight loss. Denies fevers Head/ neck: she has occasional headaches. Denies a decrease in ROM in the neck. Denies vertigo or dizziness. Denies any pain in the neck. EENT: denies sinus pain or pressure. Positive for nasal congestion and runny nose. Denies ear pain or pressure. Negative for tongue or lip swelling. Able to handle oral secretions. Denies changes in vision. Denies double vision or blurriness. Cardiac: palpitations Respiratory: denies chest pain or pressure. Denies chest tightness GI: Has feelings of heart burn. Has frequent bowel movements. Denies abdominal pain, nausea or vomiting. Heme/ Lymph: Denies swollen lymph nodes or bruising. Skin: denies skin color changes, rashes, or open wounds. Patient states hair is thinning Muscular: denies change in gait. Denies pain in arms and forearms. denies muscle weakness of the legs or feet. Denies pain of the legs or feet, denies stiffness. Medical history: none Surgical history: none Family history: grandmother had thyroid problems Social history: goes out with friends, walks daily, plays tennis ever weekend, retired Allergies: Denies any allergies to medications or food. Medications: calcium and multivitamin VS: height: 5’7” weight: 126 pounds oxygen stat: 94%, temperature is 99 degrees, BP 130/72, heart rate. PR/RR: 102 respirations 14 Constitutional: alert and oriented X3 and age appropriate. Pleasant. No distress noted. Head/ neck: normocephalic, full ROM in the neck. No facial swelling or erythematic. Denies pain in the neck. Anterior and posterior cervical lymph nodes are not swollen. Thyroid is enlarged EENT: Ears: TM’s are pearly grey bilaterally with visible landmarks and light reflex. Ear canals are patent. Eyes: PEERLA, sclera’s are white in color. Nose/Sinus: no sinus pain upon palpation, nostrils are patent with no erythema or drainage noted. Throat: no hoarseness or erythema. No bleeding or ulcers noted. Uvula with proper movement and no swelling. Lips are symmetrical/pink with no swelling. Cardiac: tachycardia, No murmurs noted. Negative for BLE. No carotid bruit. Respiratory: Chest expansion is symmetrical. Lungs are clear to auscultation. Percussion presents a resonance is noted. Tactile fremitus noted bilaterally. GI: Abdomen is non-protuberant and soft with normoactive bowel sounds. Abdomen is non- tender, and no masses or hepatosplenomegaly noted upon palpation. Normal tympanic percussion noted throughout the abdomen. Negative CVA tenderness. Skin: appropriate skin tone. Warm and dry. No open areas noted. No rashes noted. Muscular: muscle tone and bulk is appropriate throughout. Reflexes are hyper. Labs: TSH, FTH, TSI, T3, T4 Thyroid scan Assessment/Plan: Diagnosis: insomnia and thyroid disease Differentials included: hyperthyroid disease, hyperthyroid Graves’ disease, goiter, generalized anxiety Plan: Follow up in 4 weeks. Plan to discuss lab work and possibilities of PTU, thyroid scan, radioactive iodine, thyroid ablations and surgical resection. Propylthiouracil (PTU) is an oral medication that is used to manage hyperthyroidism which is due to an overactive thyroid gland. Possible endocrinologist consult for management if scan shows nodules. Discuss lifestyle changes and diet. VERSION B Subjective Jennifer Alberson Chief complaint: trouble sleeping History of present Illness: Patient is a 65 year old female. Patient presents with complaints