We have presented with four clinical cases.

We have presented with four clinical cases. For each case we have to systematically analyse and evaluate the case information to diagnose and differentiate the possible pathologies in the context of relevant contemporary clinical guidance and literature. . For each case, we have to analyse the information provided for a short case report summary to differentiate and diagnose the pathology(ies), considering the context and the key signs and symptoms. We will apply our understanding of normal and abnormal pathology to interpret, evaluate and differentiate the case study in relation to the disease processes and current literature/guidance (This is not a describing or recalling information report). This help us to formulate various potential differential diagnoses and potential treatments/management methods using systematic assessment strategies and consulting relevant clinical guidelines and references. Our case summaries should be supported by guidance from, and include references to, key health care documentation such as national standards framework/NICE guidance/academic references which are current . To structure the case report summary for each clinical case we have to evidence our consideration of the following, making use of relevant references throughout: Initial examination and analysis we have to identify and discuss the significance of any key signs/symptoms and factors which may indicate higher risk of pathology. Use relevant references to justify these. Consider what information you would request from the person or a family member, and why? Base these on clinical references. 2.Diagnosis differentiation What is your differential diagnosis and what would confirm a specific diagnosis? Justify your decision with clinical or academic references. Make a logical provisional diagnosis What other diagnostic test(s) might be requested and why? How would they help you to differentiate your provisional diagnosis? Base these on clinical references. 3.Management and treatment Evaluate the appropriate intervention, treatment and/or management and the people involved with this treatment. Base these on clinical references. Case study 1 ‘my chest hurts and I am short of breath’ A 58-year-old male presents to his local A&E department complaining of chest pain. “The pain is in the middle of my chest and came on suddenly an hour ago whilst I was watching TV. It feels like I’ve got an elephant sat on my chest doctor, it’s awful. I had a bit of tingling in my neck and jaw, but that’s gone now. I feel really nauseated, I vomited once at home before the ambulance arrived. I do feel a little short of breath, which is weird, I’ve never had that before, may be I’m just anxious. The pain isn’t affected by my position or by taking in a deep breath, it’s just always there. The pain has improved but it’s still aching and feels heavy, I’d say it was 8/10 at the start and it’s now about 5/10.” On Examination The patient has a regular pulse, is tachycardic at 110 bpm and is hypertensive with a BP of 164/112mmHg He has some xanthelasma around his eyes and also has corneal arcus. Heart sounds are normal and his chest is clear, bilateral. There is no evidence of peripheral oedema in the lower limbs. The abdomen is soft and non-tender. There is no organomegaly. There is no expansile mass on palpation of the aorta. Case study 2 ‘I have a cough that will not go’ Fred is a 48-year-old self-employed plumber who occasionally visits his doctor for a recurrent cough and upper respiratory tract infections. He has no significant past medical history is taking no medicines has no known allergies, is a regular smoker and has been since his teens, drinks a couple of alcoholic drinks per night and a few more on the weekend. He has come to you because he feels tired and is breathless when walking up the stairs. A set of observations were made by the nurse prior to your meeting with Fred. You note that Fred has recently had a fasting blood glucose test which measured 5.8mmol/l The nurse s observations for Fred are: Temperature 37°C Pulse rate 78bpm, R.R 18rpm shallow in appearance. BMI is 28KgM2 Regular blood pressure (BP) reading is 148/94 mmHg. Repeat BP 144/92 mmHg. Case study 3 “he just isn’t himself” Mr Jones is a 72-year-old gentleman who lives alone independently. He has presented to his GP, accompanied by his daughter, who is concerned “he just isn’t himself”. She feels he is quieter than usual and has been sleeping for most of the past two days. Mr Jones remembers his name but struggles with his date of birth. He believes the year is 1971 and he is at home. Mr Jones’s MMSE score is 13. You ask his daughter for more information Daughter’s answer His daughter states that Mr Jones is normally “full of life and fully with it” and hasn’t been confused in the past, remaining fully independent at home. She isn’t aware of any recent trauma, but has noticed he has become increasingly unsteady on his feet over the last 4-5 months. She knows her father is on some blood pressure tablets and also on Warfarin for “a funny heart rhythm”. She last took him to have a blood test to “check his Warfarin is working ok” about 4 weeks ago. She denies any knowledge of her father taking illicit drugs and he doesn’t drink alcohol. Examination On examination, Mr Jones is confused but alert. He is able to obey commands and his eyes are opening spontaneously. Mr Jones GCS is 14 Neurological examination of the upper and lower limbs: • Normal tone • Power 4 out of 5 in right arm • Power normal in all other limbs • Brisk right biceps and triceps reflex • Reflexes normal in all other limbs • Normal co-ordination • Normal sensation • Mild / moderate right pronator drift Cranial nerves – no deficits noted On general examination, you notice some scuffs to his left shoulder and left ear, with some mild bruising on his head just posterior to the ear. Case study 4 Post-MI complications Mrs Jenny Smith is a 60 year old woman diagnosed with a myocardial infarction three years ago. She has a BMI of 32 kg∙m2, she has controlled hypertension, which is now averaging 123/78 mm Hg, she is an ex-smoker and in the past she has been admitted on a few occasions with acute diverticulitis. Her current medication is irbesartan 150 mg per day, aspirin 75 mg per day, bisoprolol 2.5 mg per day and atorvastatin 40 mg per day. On routine review, it is noted that her blood glucose readings are between 9 and 13 mmol/l and her HbA1c is raised at 59 mmol/mol. She feels sluggish and has noticed increased thirst and polyuria. Her renal function is normal, eGFR 90 ml/min and no microalbuminuria. Case study 5 Back pain in a young man A 32-year-old man presents with a 4-year history of lower back and buttock pain. His pain is most severe at night and first thing in the morning. He finds it difficult to turn over in bed and feels very stiff when he wakes up. His symptoms start to settle after a couple of hours and improve with physical activity. He does not have any pain or numbness going down his leg and he has no bowel or urinary symptoms. He is otherwise fit and well. On examination he has significantly reduced lumbar spinal movements in all planes. He has no spinal tenderness. SCIENCE HEALTH SCIENCE NURSING PHARMACOLO M31982

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