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Question Description

Case 1 Case 2 Case 3
Chief Complaint
(CC)
A 65-year-oldmale with chronic obstructive pulmonary disease (COPD) presents to theclinic with a cough he has had for the past 2 weeks. A 25-year-old Hispanic female, computer programmer presents to your clinic complaining of a 12-day history of a runny nose A 75-year-old female reports experiencing pain in her chest while walking up steps today.
Subjective denies chest pain, denies night sweats, admits to having a fever but does not know the temp. States that hersymptoms began about 12 days ago. She suffers from allergies; she gets arunny nose during the spring-time, pollen season. However, in thewinter, her allergies are not a problem. Could not sleepprevious night. Feels like an ache or a burning sensation at the centerof sternum. Denies any arm pain, pain was at a scale of 8 in the AM nowit is at a 2. Suffers from History of hypertension, denies heartdisease, denies leg swelling up, denies pain feeling worse when takingdeep breath.
Objective Data
VS (BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air. (BP) 115/75, (P) 89, (RR) 16, (T) 100.4°F (38°C), O2 sat 98% on room air BP 129/70, (HR) 72 and regular, (RR) 16 unlabored, temperature 98.8°F, oral pulse oximetry is 99%
General patient appears tired; skin color pale, patient is diaphoretic and sweaty, height 5?3?; weight 175 lbs No signs ofacute distress. Patient appears mildly fatigued. She is breathingthrough her mouth. Breathing easily. Voice has a nasal quality to it. obese female, alert, in no acute distress.
HEENT EYES: no injection, no increase in lacrimation or purulent drainage;
EARS: normal
TM: Normal
NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Obstructed air passages
Ear canals: normal;
EYES: normal;
NOSE: Bilateral erythema and edema of turbinates with significant yellow drainage on the right. Nares: Obstructed air passages
Atraumatic,normocephalic, PERRLA, EOMI, sclera with mild icterus, nares patent,nasopharynx clear, poor dentition – multiple carries.
Respiratory lung crackles inLLL, no wheezes or rhonchi noted; does not clear with coughing; dullnessto percussion over the LLL; shallow respirations and is 30, accessorymuscles use not present CTA AP&L CTA AP&L
Neck/Throat no neck swelling or tenderness with palpation; neck is supple; no JVD; thyroid is not enlarged;
trachea midline
Posterior pharynx: mildly injected, scant postnasal drainage (PND), no exudate, tonsils 1+, no
cobblestoning
carotids are 2+ without bruits; thyroid is not palpable; no lymphadenopathy
Heart Regular rate and rhythm, no murmur, S3, or S4 Regular rate and rhythm, no murmur, S3, or S4 S1 and S2 normal without murmur, gallop, or rub

  1. What other subjective data would you obtain?
  2. What other objective findings would you look for?
  3. What diagnostic exams do you want to order?
  4. Name 3 differential diagnoses based on this patient presenting symptoms?
  5. Give rationales for your each differential diagnosis.

Your initial post should be at least 500 words, formatted and cited incurrent APA style with support from at least 3 academic sources.