Posted: December 20th, 2021

Breast Case Study 32-year-old African American female presents as a walk-in at your local Federally Qualified Health Center

Breast Case Study

32-year-old African American female presents as a walk-in at your local Federally Qualified Health Center. She reports a lump in the right breast for 4 months that is increasing in size.
PMH: Denies
FH: Denies
Social History: Frequent marijuana use Allergies: None
HPI
O: breast lump palpated 4 months ago
L: right breast
D: the lump has increased in size since initial palpation C: small, quarter sized lump
A: tenderness at the site with monthly menstrual cycle R: Denies
T: Denies
1). The Nurse Practitioner completes a clinical breast exam. There is a dime-sized nodule palpated in the right breast at the 4 o’clock position. The patient has pendulous breast with an inverted right nipple. What is your treatment plan (referrals, community resources)?

2). What education would you provide your female patients based on the American Cancer Society Breast Cancer guidelines?

Lung Case Study

43-year-old Caucasian female reports shortness of breath, fatigue and unintentional weight loss of 25 pounds for 1 month.
PMH: Hypertension
SH: Complete hysterectomy
Social History: Tobacco abuse since the age of 12; 2 ppd
FH: Hypothyroidism-mother Muscular dystrophy-father
Allergies: Shellfish
HPI
O: shortness of breath, fatigue and unintentional weight loss x 1 month
L: bilateral lungs, generalized fatigue
D: constant shortness of breath with rest and activity
C: denies wheezing and cough
A: shortness of breath aggravated with walking up stairs
R: Denies
T: prescribed Symbicort 160mcg/4.5 mcg and Proventil HFA inhaler with no relief of shortness of breath
1). What workup would you consider? Provide a rationale.

2). At what point during the treatment plan would you refer to an Oncologist?

Gastro-intestinal Case Study 1.
Age: 67
Male
African American
BP: 90/60
HR: 93
Hemoglobin in office: 5.4
Chief Complaint: “I have been feeling very dizzy lately” PMH: Diabetes and hypertension
Hx of Hepatitis A 20 years ago after foreign travel FH:
Allergies: none
HPI:
O: over the last 2 months but worsen over the past week L: primarily feeling dizzy in his head
D: over the last 2 months but worsen over the past week, when the dizziness occurs it last for about 30 seconds
C: Dizziness upon standing but can be sitting still and become dizzy, denies palpitations or shortness of breath and had one near fainting episode after bending over to pick up grandchild, denies ear pain, congestion, cough, or headache,
Associated: Has been having black stools for about 2 months. Stopped taking blood pressure medication for the past 3 weeks because he thought that his blood pressure medication was the cause, but it keeps occurring. He states that he has lost about 15 lbs within the last month due to having a poor appetite. He denies vomiting or nausea or difficulty swallowing
Aggravating: changes in position T: None
1. What is your primary diagnosis?

2. As a primary care provider what is your next step?

Genitourinary Case Study
Age: 57
Female
Caucasian
BP: 154/96
HR: 87
Hemoglobin a1c 6.0
Hemoglobin: 10.1
Chief Complaint: “I keep bleeding from my vaginal area” PMH: Diabetes and Hypertension, post-menopausal
FH: Mother with myocardial infarction Allergies: none
HPI:
O: 3 months
L: vaginal area
D: episodically over the past 3 months
C: Bleeding from vaginal area after urinating occasion. However, the bleeding occurs after each sexual encounter. She denies any burning or pain with urination. She denies painful sex or lower abdominal pain or vaginal discharge.
Associated: She has been in a monogamous relationship for 30 years. Prior to these symptoms she had not had a cycle in 6 years. She has not had a pap smear in over 10 years.
Aggravating: sexual intercourse T: None
1. What are potential diagnoses?

2. As a primary care provider what is your next step?

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