Problem
• Review New Case: Patient Mary is a 62- year-old female.
• Chief Complaint: presenting with epigastric pain.
• History of Present Illness: pain over sternum, radiating to neck that is worsening over last 3 months. Notices pain starts about 30 minutes after eating and lasts about 4 - 5 hours. Heavy meals, coffee and spicy foods make it worse. Finds she needs to sleep on 3 pillows at night or she "spits up" a little. At times notices a slight cough and hoarseness - denies fever or chills. Has tried Maalox & Tums with some mild relief of symptoms.
• Past Medical History: Elevated cholesterol & triglycerides
• Family History: Non-contributory
• Social History: Smokes ½ ppd for the last 30 years. Drinks a bottle of wine every Friday & Saturday night. Denies recreational drug use. Employed as a high-school teacher.
• Current Medications: Lipitor 10 mg daily
• Allergies: Penicillin
• Vital signs: T: 98.7 P: 86 R: 14 BP: 160/100 O2Sat: 96% Ht: 5'3" Wt: 192 lbs
• Pertinent physical exam findings:
• HEENT: moderate erythema in posterior pharynx; dome dental erosion with teeth staining
• Neck: no lymphadenopathy; thyroid nonpalpable; carotids 2+; no bruits
• Cardiac: regular rate & rhythm, no murmurs, clicks, gallops, rubs
• Respiratory: lungs clear bilaterally
• Abdomen: soft; obese; positive bowel sounds; mild epigastric te3neerness on palpation but without rebound or guarding; no organomegaly noted.
• Point of Care Testing Completed (on-site): urinalysis - no abnormal findings; stool positive for guaiac.
Complete the following questions and post to Discussion Board on Blackboard Module:
i. Wha tare the patient's most significant key presenting features & risk factors?
ii. What are your top three Differential Diagnoses and why?
iii. What additional diagnostic or imaging testing should be ordered and why?
iv. What is the patient's most likely diagnosis?
v. How is the patient's condition typically treated?