Assignment task:
CC: 51-year-old Caucasian female complains of racing heart and unexplained weight loss.
HPI: She states symptoms have been becoming more noticeable over the last year. She has lost about 10 pounds without trying over about 12 months.
Although it may be because she is working more. Complains of feeling heart racing and fluttering sensation in her chest. Happens most every day but started out occasionally. Denies any chest pain. Denies having been ill or having COVID over the past two years. Thought it might be stress related or too much coffee. She stopped drinking coffee about four months ago, but symptoms have continued. Stress in life is minimal. Sleep is not refreshing; gets about 7 hours a night. Occasional hot flashes at random times of day and night. Chalks it up to menopause.
PMH: Denies any chronic medical conditions. She had her wisdom teeth surgically removed at age 15. Two normal spontaneous vaginal births; 2 daughters aged 18 and 20. Last physical exam was two years ago which was a pre-employment physical. Last pap smear three years ago and normal.
Meds: She takes a daily multivitamin.
FH: Her father is 77 and has hypertension, her mom is 75 and is healthy.
She has a brother who is 54 who is obese and has diabetes. She has two aunts on her mother's side who have thyroid problems and one uncle on father's side with diabetes. She has breast cancer in a couple of aunts on her father side.
SH: She is divorced of five years, lives in an apartment alone with a dog. She works as a physical therapist. She does not use tobacco products and never has, she socially consumes alcohol, maybe 6 drinks a month. She does not use illicit drugs, ever. She has not been sexually active in three years. She exercises regularly, mostly hiking or neighborhood walks daily with her dog.
NKDA, No food allergies, + environmental allergies ROS:
General: no fevers, night sweats, +fatigue, + weight loss
Skin: moist, c/o's thinning hair
HEENT: denies vision changes, also needs to use readers for up close, denies eye discharge, denies nasal congestion or sneezing, denies hearing changes or ear pain, or sore throat.
Cardio: denies chest pain, + for palpitations on and off
Pulmonary: denies cough or shortness of breath
GI: denies abdominal pain, denies vomiting, constipation. + for bouts of "looser" stools and occasional nausea.
GU: Denies increase in urination, pain or frequency. LMP 6 months ago, always irregular over past couple of years, states perimenopausal.
MSK/Neuro: Denies joint pain or loss of range of motion, denies numbness tingling that changes in sensation, + does feel weaker overall though.
Occasionally notices tremors in hands as well.
Psych: Denies depression however sometimes feels anxious and or irritable for no reason.
VS: BP: 165/94 P: 110 RR: 18 T: 98.6 Ht: 66in Wt: 115lbs BMI: 18.6
PE: General: pleasant, alert mildly anxious appearing, thin adult female in no acute distress.
Skin: moist, without lesions, fingernails brittle and chipped.
HEENT: PERRLA, eyes clear, w/o discharge, TM'S intact, canals clear, mouth moist, w/o lesions, tonsils 2+ no erythema, thyroid palpable, but smooth.
Heart: Tachy, regular rhythm, no murmurs, rubs or gallops.
Lungs: CTA Bilat. Resonant breath sounds, no crackles.
Abdominal: Soft, round, non-tender to palpation
Create a list of three to five differential diagnosis (or you may develop a VINDICATE differential list if preferred) based on the patient's presentation, HPI, and PE.
Create a pathophysiology concept map/flow chart. In that flow chart compare and contrast these two diagnoses documenting how the two diagnoses are similar in looking at their symptoms, physical examination and labs, and document how the two diagnoses are different.