Question

A 29-year old female comes for an office visit to her nurse practitioner because she feels jittery, anxious, and easily sweating, especially in her palms since a while ago, probably more than 3 years ago. Her old friend that she has meet recently also said that she seems to have lost weight but her lower front neck seems bigger than normal people, which the patient dismiss it as something ridiculous. She claims she has been healthy all her life, and she is trying to eat healthy and exercise regularly by doing yoga at least once a week. She doesn’t smoke but she drinks alcohol socially with friends. She is happily married with one 4-year old healthy child. Her husband works in construction, while she is an administrative assistant at a local public school. She denied having heart palpitation, and her menstruation has been irregular as always since she got it the first time when she was 13 years old.

Physical exam:

Temperature: 37.6^o Celsius (normal: 36.1⁰-37.2⁰)

Blood pressure: 120/75 mmHg (normal: 120/80 mmHg)

heart rate: 115 beat/minute, irregular (normal 60-100 x/minute)

respiratory rate: 20/minute (normal 12 – 20 x/minute)

A thin looking woman, that kept shifting her sitting positions.

There is a soft mass in her right and left lower neck, most likely her thyroid glands, both size 2x2x1 cm. No pain on palpation.

Her eyes protruding, most likely an exophthalmos.

Her palms are sweaty, but no tremors.

Heart: heart sounds irregular, no murmurs. Most likely an atrial fibrillation. No heart enlargement

Lung: clear on auscultation.

Other physical exam is normal.

Chief complaint: (fill this in based on the short history above): abdominal pain, nausea and vomiting

EXAMPLE:

History of present illness: (fill this based on the story above, making summary of his current illness):  (how long does he has cough, fever, sneezing) He has cough, fever, and sneezing for 4 days  (how long does he has abdominal pain, nausea and vomiting) He complaints of abdominal pain, nausea and vomiting since this afternoon  (what treatment he has taken for the current illness) He has taken Tylenol

History of past illness: (fill this based on the story above, making summary of his past/chronic illness):  Jim has been diagnosed with diabetes type 1 for 3 years and he has taken insulin shots that he manages it himself twice a day. The last time he did was 3 hours before admission to the ER.

Family history: (fill this based on the story above, making any relevant family history if any)  None.

Possible diagnoses (Differential diagnoses): (write the order from the most likely to the least like diagnoses)

1. Diabetic ketoacidosis (DKA)

2. Hyperglycemia

3. Hypoglycemia

Explanation of pathophysiology of each of the differential diagnoses: (explain the pathophysiology of the differential diagnoses you choose above in 3-5 paragraphs each, along with the reason you think this patient fit your diagnoses)

1. Diabetic ketoacidosis (DKA) pathophysiology: 3 – 5 paragraphs. In this case, Jim’s DKA is probably exacerbated by a common cold or other upper respiratory tract infection. Student’s name: ______________________________________ Bio240 Individual Project 1

2. Hyperglycemia in diabetes mellitus type 1 pathophysiology: 3 – 5 paragraphs. In this case, probably Jim has not comply with his insulin shot, but he has not develop ketosis as yet.

3. Hypoglycemia pathophysiology: 3 – 5 paragraphs. In this case, probably Jim has been taking his insulin shots but he doesn’t have enough food intake due to his nausea and vomiting. It makes his blood sugar lower than normal, and insulin shots make it even lower. Hence hypoglycemia.