Directions: Be sure to review the Case Study 1 Grading Rubric for details on expectations of quality of
answer. Read the case study and complete the answers in your own words to the ten questions below
using the following guidelines:
• Use complete sentences.
• Use at least four sentences for each question.
• Include an in-text citation at the end of each question.
• Include at least four references with one being your textbook. No websites unless it is epocrates,
uptodate or medscape, please use medical textbooks, and NP or MD journal articles.
Note: Plagiarism or cut and paste from the internet will result in a zero for the assignment.
Case Study for NP students
A 38-year-old African American male presents to the clinic with mild headache, dizziness, and fatigue.
He has not seen a health care provider in 8 years. He states that he is “tired of being tired all the time.”
Weight: 240 lbs; Height 5’10”; waist to hip ratio > 2:1. He rates his headache 5/10 and describes as a
constant, throbbing pressure distributed evenly over the top of his head. His symptoms are worse in the
morning than evening. Tylenol and Ibuprofen help, pain is 2/10 after medication. He thinks he may have
“blood pressure problems like his father”. He also reports increased thirst, hunger, and urination. Denies
chest pain, injuries, physical trauma, or recent illness. His family history is positive for hypertension,
coronary artery disease, and Type II Diabetes. Vital signs: HR 96, BP 160/86, RR 20, SpO2 98%.
Psychosocial: sells insurance, occasionally feels stressed from work.
Diet & Lifestyle: sedentary, frequently eats at local fast food restaurants. Denies tobacco use.
Occasionally consumes alcohol, three or four times/year.
Physical Exam:
General: Alert & oriented to person, place, and time. Appropriately dressed & groomed with good
hygiene. Calm & cooperative.
Mental status: Oriented x3, speech appropriate, clear.
HEENT: normocephalic, without deformities, no evidence of trauma. Hair with normal distribution &
texture. Eyelids, sclera, and conjunctiva normal. PERRLA, EOM full, no cataracts, fundoscopic exam
revealed mild nicking of retinal vessels and a few cotton wool spots. Ears w/normal appearing pinnae &
auditory canals, tympanic membrane pearly gray, glistening, w/o retraction or bulging, normal light
reflex, hearing intact. Nose without deformity, patent nares, pale pink, moist mucosa, normal
turbinates, no deviation of septum or polyps noted. No tenderness to palpation of frontal or maxillary
sinuses or nares. Buccal and tongue mucosa pink and moist. No lesions noted under tongue or inside
mouth. Teeth in good repair, no evidence of gum disease. Tonsils not enlarged or red, oropharynx
patent. Thyroid midline, no enlargement or nodularity present. No palpable lymph nodes in neck or
supraclavicular fossa. No cervical masses. Trachea midline.
Breasts, Axilla, Epitrochlear nodes: deferred.
This study source was downloaded by 100000901524459 from CourseHero.com on 11-17-2025 15:58:21 GMT -06:00
https://www.coursehero.com/file/224554160/Case-Study-One-Gabe-Jones-with-Questions-for-NP-studentsdocx/
, Cardiovascular: Carotids w/+3 pulses, no bruits. No JVD. Cardiac PMI in 5 th intercostal space at
midclavicular line. No lift or abnormal pulsations. S1&S2 present w/normal quality. No murmurs, gallops,
or clicks noted. +2 peripheral pulses, normal rate & rhythm.
Chest & Lungs: clear in upper & lower fields. No fremitus. No pectus excavatum or carinatum present.
Normal respiratory pattern, inhalation & expiration full without use of accessory muscles. A-P diameter
2:1. No deformities of thorax seen.
Abdomen: Normal bowel sounds, soft, nondistended, nontender. Liver, kidneys, spleen not palpable.
Aortic pulsation palpable within normal limits.
Back: no scoliosis, kyphosis, or lordosis seen. No CVA tenderness.
Extremities: Acanthosis nigricans noted around neck and under arms. Skin warm & dry. No abnormal
lesions noted. Mild, non-pitting edema to and hands and feet. Normal venous pattern. No varicosities
seen.
Genitals: deferred.
Rectal: deferred.
Musculoskeletal: Full ROM, no joint/extremity deformities,
Neuro: cranial nerves intact, DTR’s +2, negative Homan’s sign. No ankle clonus. Motor intact, no focal
weakness, normal muscle tone.
Coordination: smooth, coordinated movements.
Sensation: intact to pain, light touch, proprioception & vibration. No graphesthesia or stereognosis.
Complete the following questions.
1. List the top three differential diagnoses with rationale for each.
Diabetes Mellitus Type 2– Based on the increase waist circumference, acanthosis nigricans, and
family history, my primary concern would be diabetes mellitus type 2. The patient is also
presenting with the three polys which include polyuria, polydipsia, and polyphagia (Norris, 2019,
p 1222). The patient also has mild nicking of retinal vessels and cotton wool spots on the
fundoscopic exam.
Hypertension – Based on the physical exam, hypertension would be a differential diagnosis to
consider as well. The patient presented with cotton wool spots and arteriovenous nicking on the
fundoscopic exam which would be consistent with hypertension (Basile & Bloch, 2023). The
patient is also at an increased risk for hypertension based on the family history of hypertension
(Basile & Bloch, 2023).
Chronic Kidney Disease – Based on the physical exam, chronic kidney would be a differential
diagnosis to consider as well, even though it is less likely to be the cause of the symptoms. The
patient presented with headaches, fatigue, and excessive thirst which could all indicate a
diagnosis of chronic kidney disease (Vaidya & Aeddula, 2022). Also, the patient is at a higher risk
This study source was downloaded by 100000901524459 from CourseHero.com on 11-17-2025 15:58:21 GMT -06:00
https://www.coursehero.com/file/224554160/Case-Study-One-Gabe-Jones-with-Questions-for-NP-studentsdocx/
answer. Read the case study and complete the answers in your own words to the ten questions below
using the following guidelines:
• Use complete sentences.
• Use at least four sentences for each question.
• Include an in-text citation at the end of each question.
• Include at least four references with one being your textbook. No websites unless it is epocrates,
uptodate or medscape, please use medical textbooks, and NP or MD journal articles.
Note: Plagiarism or cut and paste from the internet will result in a zero for the assignment.
Case Study for NP students
A 38-year-old African American male presents to the clinic with mild headache, dizziness, and fatigue.
He has not seen a health care provider in 8 years. He states that he is “tired of being tired all the time.”
Weight: 240 lbs; Height 5’10”; waist to hip ratio > 2:1. He rates his headache 5/10 and describes as a
constant, throbbing pressure distributed evenly over the top of his head. His symptoms are worse in the
morning than evening. Tylenol and Ibuprofen help, pain is 2/10 after medication. He thinks he may have
“blood pressure problems like his father”. He also reports increased thirst, hunger, and urination. Denies
chest pain, injuries, physical trauma, or recent illness. His family history is positive for hypertension,
coronary artery disease, and Type II Diabetes. Vital signs: HR 96, BP 160/86, RR 20, SpO2 98%.
Psychosocial: sells insurance, occasionally feels stressed from work.
Diet & Lifestyle: sedentary, frequently eats at local fast food restaurants. Denies tobacco use.
Occasionally consumes alcohol, three or four times/year.
Physical Exam:
General: Alert & oriented to person, place, and time. Appropriately dressed & groomed with good
hygiene. Calm & cooperative.
Mental status: Oriented x3, speech appropriate, clear.
HEENT: normocephalic, without deformities, no evidence of trauma. Hair with normal distribution &
texture. Eyelids, sclera, and conjunctiva normal. PERRLA, EOM full, no cataracts, fundoscopic exam
revealed mild nicking of retinal vessels and a few cotton wool spots. Ears w/normal appearing pinnae &
auditory canals, tympanic membrane pearly gray, glistening, w/o retraction or bulging, normal light
reflex, hearing intact. Nose without deformity, patent nares, pale pink, moist mucosa, normal
turbinates, no deviation of septum or polyps noted. No tenderness to palpation of frontal or maxillary
sinuses or nares. Buccal and tongue mucosa pink and moist. No lesions noted under tongue or inside
mouth. Teeth in good repair, no evidence of gum disease. Tonsils not enlarged or red, oropharynx
patent. Thyroid midline, no enlargement or nodularity present. No palpable lymph nodes in neck or
supraclavicular fossa. No cervical masses. Trachea midline.
Breasts, Axilla, Epitrochlear nodes: deferred.
This study source was downloaded by 100000901524459 from CourseHero.com on 11-17-2025 15:58:21 GMT -06:00
https://www.coursehero.com/file/224554160/Case-Study-One-Gabe-Jones-with-Questions-for-NP-studentsdocx/
, Cardiovascular: Carotids w/+3 pulses, no bruits. No JVD. Cardiac PMI in 5 th intercostal space at
midclavicular line. No lift or abnormal pulsations. S1&S2 present w/normal quality. No murmurs, gallops,
or clicks noted. +2 peripheral pulses, normal rate & rhythm.
Chest & Lungs: clear in upper & lower fields. No fremitus. No pectus excavatum or carinatum present.
Normal respiratory pattern, inhalation & expiration full without use of accessory muscles. A-P diameter
2:1. No deformities of thorax seen.
Abdomen: Normal bowel sounds, soft, nondistended, nontender. Liver, kidneys, spleen not palpable.
Aortic pulsation palpable within normal limits.
Back: no scoliosis, kyphosis, or lordosis seen. No CVA tenderness.
Extremities: Acanthosis nigricans noted around neck and under arms. Skin warm & dry. No abnormal
lesions noted. Mild, non-pitting edema to and hands and feet. Normal venous pattern. No varicosities
seen.
Genitals: deferred.
Rectal: deferred.
Musculoskeletal: Full ROM, no joint/extremity deformities,
Neuro: cranial nerves intact, DTR’s +2, negative Homan’s sign. No ankle clonus. Motor intact, no focal
weakness, normal muscle tone.
Coordination: smooth, coordinated movements.
Sensation: intact to pain, light touch, proprioception & vibration. No graphesthesia or stereognosis.
Complete the following questions.
1. List the top three differential diagnoses with rationale for each.
Diabetes Mellitus Type 2– Based on the increase waist circumference, acanthosis nigricans, and
family history, my primary concern would be diabetes mellitus type 2. The patient is also
presenting with the three polys which include polyuria, polydipsia, and polyphagia (Norris, 2019,
p 1222). The patient also has mild nicking of retinal vessels and cotton wool spots on the
fundoscopic exam.
Hypertension – Based on the physical exam, hypertension would be a differential diagnosis to
consider as well. The patient presented with cotton wool spots and arteriovenous nicking on the
fundoscopic exam which would be consistent with hypertension (Basile & Bloch, 2023). The
patient is also at an increased risk for hypertension based on the family history of hypertension
(Basile & Bloch, 2023).
Chronic Kidney Disease – Based on the physical exam, chronic kidney would be a differential
diagnosis to consider as well, even though it is less likely to be the cause of the symptoms. The
patient presented with headaches, fatigue, and excessive thirst which could all indicate a
diagnosis of chronic kidney disease (Vaidya & Aeddula, 2022). Also, the patient is at a higher risk
This study source was downloaded by 100000901524459 from CourseHero.com on 11-17-2025 15:58:21 GMT -06:00
https://www.coursehero.com/file/224554160/Case-Study-One-Gabe-Jones-with-Questions-for-NP-studentsdocx/
