Blood is classified based on the presence or absence of anti…

Questions

Blооd is clаssified bаsed оn the presence or аbsence of antigens on the surface of what?

Reаd the fоllоwing cаse scenаriо, written in SOAP-format. Then answer the following question. Patient Information Name: Ava KimAge: 2 yearsSex: FemaleRace/Ethnicity: Asian American Setting Ava Kim is a 2-year-old Asian American female who presents to her pediatrician's office accompanied by her mother with complaints of right ear pain, fever, and increased fussiness. Chief Complaint (CC) Mother states: "She's been pulling at her right ear and crying most of the night." History of Present Illness (HPI) Ava's mother reports that her daughter began developing nasal congestion and a runny nose approximately five days ago. Two days ago, Ava became increasingly fussy and developed a low-grade fever. During the past 24 hours, she has been pulling at her right ear, crying whenever she lies down, and has been difficult to console. Her mother reports that Ava awoke several times during the night crying and refused to sleep on her right side. She has had a decreased appetite but continues to drink fluids. She has had several wet diapers today. The mother has been administering acetaminophen, which temporarily reduces the fever and improves Ava's comfort. She denies vomiting, diarrhea, rash, difficulty breathing, neck stiffness, ear drainage, facial swelling, recent trauma, or foreign body insertion into the ear. No known sick contacts outside of daycare, although several children in her classroom recently had colds. Past Medical History Full-term vaginal delivery without complications Normal growth and development Two previous episodes of acute otitis media, both successfully treated with oral antibiotics Immunizations current according to CDC schedule Surgical History None Medications Acetaminophen as needed for fever No daily medications Allergies No known drug allergies Family History Mother: Seasonal allergic rhinitis Father: Healthy Maternal grandmother: Hypertension No family history of congenital hearing loss, recurrent ear infections requiring tympanostomy tubes, or immunodeficiency disorders Social History Lives with both parents and an older brother Attends daycare five days per week No tobacco exposure in the home Uses an age-appropriate car seat Drinks from a cup during the day but occasionally uses a bottle before bedtime Developmental milestones appropriate for age Review of Systems (ROS) General Mother reports fever, increased irritability, decreased appetite, and poor sleep. Denies lethargy or weight loss. Skin Denies rash, bruising, or skin lesions. HEENT Head: Denies head injury. Eyes: Denies redness, drainage, swelling, or visual concerns. Ears: Reports pulling at the right ear, increased crying when lying down, and apparent right ear pain. Denies ear drainage or bleeding. Nose: Reports nasal congestion and clear rhinorrhea for five days. Throat: Mild decrease in appetite but continues drinking fluids. Denies drooling or difficulty swallowing. Respiratory Reports mild cough associated with nasal congestion. Denies wheezing, stridor, shortness of breath, or increased work of breathing. Cardiovascular Denies cyanosis or decreased activity tolerance. Gastrointestinal Reports decreased appetite. Denies vomiting, diarrhea, or abdominal pain. Genitourinary Normal urine output with several wet diapers today. Musculoskeletal Denies neck stiffness or extremity pain. Neurological Mother reports increased fussiness but denies seizures, altered level of consciousness, or weakness. Objective Assessment Findings Vital Signs Temperature: 101.8°F (38.8°C) Heart Rate: 122 beats/min Respiratory Rate: 26 breaths/min Blood Pressure: 92/58 mmHg Oxygen Saturation: 99% on room air Weight: 13.2 kg (29 lb) Physical Examination General Alert, irritable toddler sitting on mother's lap. Cries during the examination but is consolable. Appears mildly ill but nontoxic. Skin Warm, pink, and dry. No rash or lesions. Head Normocephalic and atraumatic. Eyes Conjunctivae clear. Sclerae white. Pupils equal, round, and reactive to light. Extraocular movements intact. Ears Right Ear External ear normal without swelling or erythema. Ear canal patent without edema or drainage. Tympanic membrane is erythematous, __________, opaque, and has ______of normal landmarks. Decreased mobility of the tympanic membrane with pneumatic otoscopy. No perforation observed. Left Ear External ear and canal normal. Tympanic membrane pearly gray, translucent, with normal landmarks and normal mobility. Nose Nasal mucosa mildly erythematous with clear rhinorrhea. Mouth/Throat Oral mucosa pink and moist. Mild posterior pharyngeal erythema without tonsillar enlargement or exudate. Neck Supple. Small, mobile, mildly tender right anterior cervical lymph node palpated. No meningismus. Respiratory Respirations even and unlabored. Lungs clear to auscultation bilaterally. Cardiovascular Regular rate and rhythm. No murmurs. Capillary refill less than 2 seconds. Abdomen Soft, nondistended, nontender. Normoactive bowel sounds. Neurological Alert and interactive. Age-appropriate behavior. No focal neurologic deficits. Diagnostics No laboratory studies or imaging have been obtained prior to today's evaluation. No tympanocentesis performed. ___________________________________________________________________ After reviewing Ava Kim's history and the otoscopic image of her right ear (see below), which diagnosis is most consistent with the assessment findings? 

Reаd the fоllоwing cаse scenаriо, written in SOAP-format. Answer the following question. Patient Information Name: Ava KimAge: 2 yearsSex: FemaleRace/Ethnicity: Asian American Setting Ava Kim is a 2-year-old Asian American female who presents to her pediatrician's office accompanied by her mother with complaints of right ear pain, fever, and increased fussiness. Chief Complaint (CC) Mother states: "She's been pulling at her right ear and crying most of the night." History of Present Illness (HPI) Ava's mother reports that her daughter began developing nasal congestion and a runny nose approximately five days ago. Two days ago, Ava became increasingly fussy and developed a low-grade fever. During the past 24 hours, she has been pulling at her right ear, crying whenever she lies down, and has been difficult to console. Her mother reports that Ava awoke several times during the night crying and refused to sleep on her right side. She has had a decreased appetite but continues to drink fluids. She has had several wet diapers today. The mother has been administering acetaminophen, which temporarily reduces the fever and improves Ava's comfort. She denies vomiting, diarrhea, rash, difficulty breathing, neck stiffness, ear drainage, facial swelling, recent trauma, or foreign body insertion into the ear. No known sick contacts outside of daycare, although several children in her classroom recently had colds. Past Medical History Full-term vaginal delivery without complications Normal growth and development Two previous episodes of acute otitis media, both successfully treated with oral antibiotics Immunizations current according to CDC schedule Surgical History None Medications Acetaminophen as needed for fever No daily medications Allergies No known drug allergies Family History Mother: Seasonal allergic rhinitis Father: Healthy Maternal grandmother: Hypertension No family history of congenital hearing loss, recurrent ear infections requiring tympanostomy tubes, or immunodeficiency disorders Social History Lives with both parents and an older brother Attends daycare five days per week No tobacco exposure in the home Uses an age-appropriate car seat Drinks from a cup during the day but occasionally uses a bottle before bedtime Developmental milestones appropriate for age Review of Systems (ROS) General Mother reports fever, increased irritability, decreased appetite, and poor sleep. Denies lethargy or weight loss. Skin Denies rash, bruising, or skin lesions. HEENT Head: Denies head injury. Eyes: Denies redness, drainage, swelling, or visual concerns. Ears: Reports pulling at the right ear, increased crying when lying down, and apparent right ear pain. Denies ear drainage or bleeding. Nose: Reports nasal congestion and clear rhinorrhea for five days. Throat: Mild decrease in appetite but continues drinking fluids. Denies drooling or difficulty swallowing. Respiratory Reports mild cough associated with nasal congestion. Denies wheezing, stridor, shortness of breath, or increased work of breathing. Cardiovascular Denies cyanosis or decreased activity tolerance. Gastrointestinal Reports decreased appetite. Denies vomiting, diarrhea, or abdominal pain. Genitourinary Normal urine output with several wet diapers today. Musculoskeletal Denies neck stiffness or extremity pain. Neurological Mother reports increased fussiness but denies seizures, altered level of consciousness, or weakness. Objective Assessment Findings Vital Signs Temperature: 101.8°F (38.8°C) Heart Rate: 122 beats/min Respiratory Rate: 26 breaths/min Blood Pressure: 92/58 mmHg Oxygen Saturation: 99% on room air Weight: 13.2 kg (29 lb) Physical Examination General Alert, irritable toddler sitting on mother's lap. Cries during the examination but is consolable. Appears mildly ill but nontoxic. Skin Warm, pink, and dry. No rash or lesions. Head Normocephalic and atraumatic. Eyes Conjunctivae clear. Sclerae white. Pupils equal, round, and reactive to light. Extraocular movements intact. Ears Right Ear External ear normal without swelling or erythema. Ear canal patent without edema or drainage. Tympanic membrane is erythematous, bulging, opaque, and has loss of normal landmarks. Decreased mobility of the tympanic membrane with pneumatic otoscopy. No perforation observed. Left Ear External ear and canal normal. Tympanic membrane pearly gray, translucent, with normal landmarks and normal mobility. Nose Nasal mucosa mildly erythematous with clear rhinorrhea. Mouth/Throat Oral mucosa pink and moist. Mild posterior pharyngeal erythema without tonsillar enlargement or exudate. Neck Supple. Small, mobile, mildly tender right anterior cervical lymph node palpated. No meningismus. Respiratory Respirations even and unlabored. Lungs clear to auscultation bilaterally. Cardiovascular Regular rate and rhythm. No murmurs. Capillary refill less than 2 seconds. Abdomen Soft, nondistended, nontender. Normoactive bowel sounds. Neurological Alert and interactive. Age-appropriate behavior. No focal neurologic deficits. Diagnostics No laboratory studies or imaging have been obtained prior to today's evaluation. No tympanocentesis performed. ----------------------------------------------------------------------------------------------------------------------- During Ava Kim's urgent care visit, the APRN obtains the health history and performs a physical examination. Match each statement with the appropriate section of the SOAP note where the information would be documented:

Reаd the fоllоwing cаse scenаriо, as documented in a "SO"AP format. Then follow the directions. Patient Information Name: Ava KimAge: 2 yearsSex: FemaleRace/Ethnicity: Asian American Setting Ava Kim is a 2-year-old Asian American female who presents to her pediatrician's office accompanied by her mother with complaints of right ear pain, fever, and increased fussiness. Chief Complaint (CC) Mother states: "She's been pulling at her right ear and crying most of the night." History of Present Illness (HPI) Ava's mother reports that her daughter began developing nasal congestion and a runny nose approximately five days ago. Two days ago, Ava became increasingly fussy and developed a low-grade fever. During the past 24 hours, she has been pulling at her right ear, crying whenever she lies down, and has been difficult to console. Her mother reports that Ava awoke several times during the night crying and refused to sleep on her right side. She has had a decreased appetite but continues to drink fluids. She has had several wet diapers today. The mother has been administering acetaminophen, which temporarily reduces the fever and improves Ava's comfort. She denies vomiting, diarrhea, rash, difficulty breathing, neck stiffness, ear drainage, facial swelling, recent trauma, or foreign body insertion into the ear. No known sick contacts outside of daycare, although several children in her classroom recently had colds. Past Medical History Full-term vaginal delivery without complications Normal growth and development Two previous episodes of acute otitis media, both successfully treated with oral antibiotics Immunizations current according to CDC schedule Surgical History None Medications Acetaminophen as needed for fever No daily medications Allergies No known drug allergies Family History Mother: Seasonal allergic rhinitis Father: Healthy Maternal grandmother: Hypertension No family history of congenital hearing loss, recurrent ear infections requiring tympanostomy tubes, or immunodeficiency disorders Social History Lives with both parents and an older brother Attends daycare five days per week No tobacco exposure in the home Uses an age-appropriate car seat Drinks from a cup during the day but occasionally uses a bottle before bedtime Developmental milestones appropriate for age Review of Systems (ROS) General Mother reports fever, increased irritability, decreased appetite, and poor sleep. Denies lethargy or weight loss. Skin Denies rash, bruising, or skin lesions. HEENT Head: Denies head injury. Eyes: Denies redness, drainage, swelling, or visual concerns. Ears: Reports pulling at the right ear, increased crying when lying down, and apparent right ear pain. Denies ear drainage or bleeding. Nose: Reports nasal congestion and clear rhinorrhea for five days. Throat: Mild decrease in appetite but continues drinking fluids. Denies drooling or difficulty swallowing. Respiratory Reports mild cough associated with nasal congestion. Denies wheezing, stridor, shortness of breath, or increased work of breathing. Cardiovascular Denies cyanosis or decreased activity tolerance. Gastrointestinal Reports decreased appetite. Denies vomiting, diarrhea, or abdominal pain. Genitourinary Normal urine output with several wet diapers today. Musculoskeletal Denies neck stiffness or extremity pain. Neurological Mother reports increased fussiness but denies seizures, altered level of consciousness, or weakness. Objective Assessment Findings Vital Signs Temperature: 101.8°F (38.8°C) Heart Rate: 122 beats/min Respiratory Rate: 26 breaths/min Blood Pressure: 92/58 mmHg Oxygen Saturation: 99% on room air Weight: 13.2 kg (29 lb) Physical Examination General Alert, irritable toddler sitting on mother's lap. Cries during the examination but is consolable. Appears mildly ill but nontoxic. Skin Warm, pink, and dry. No rash or lesions. Head Normocephalic and atraumatic. Eyes Conjunctivae clear. Sclerae white. Pupils equal, round, and reactive to light. Extraocular movements intact. Ears Right Ear External ear normal without swelling or erythema. Ear canal patent without edema or drainage. Tympanic membrane is erythematous, bulging, opaque, and has loss of normal landmarks. Decreased mobility of the tympanic membrane with pneumatic otoscopy. No perforation observed. Left Ear External ear and canal normal. Tympanic membrane pearly gray, translucent, with normal landmarks and normal mobility. Nose Nasal mucosa mildly erythematous with clear rhinorrhea. Mouth/Throat Oral mucosa pink and moist. Mild posterior pharyngeal erythema without tonsillar enlargement or exudate. Neck Supple. Small, mobile, mildly tender right anterior cervical lymph node palpated. No meningismus. Respiratory Respirations even and unlabored. Lungs clear to auscultation bilaterally. Cardiovascular Regular rate and rhythm. No murmurs. Capillary refill less than 2 seconds. Abdomen Soft, nondistended, nontender. Normoactive bowel sounds. Neurological Alert and interactive. Age-appropriate behavior. No focal neurologic deficits. Diagnostics No laboratory studies or imaging have been obtained prior to today's evaluation. No tympanocentesis performed. ---------------------------------------------------------------------------------- Based on Ava Kim's history and physical examination findings:  Explain whether additional diagnostic testing is indicated. Identify three (3) "red flag" findings that would warrant additional evaluation or referral and explain why. Directions: Respond in 3-4 well-developed paragraphs using in-text citations when needed. Course book(s), course lecture notes, and course content are the only resources allowed to use. A reference page is not required. *Please see the attached rubric.

Whаt is the primаry rоute оf diseаse transmissiоn in a healthcare facility?

/cоntent/enfоrced2/8034374-APSU_202014_NURS2020_NURS_NURS2020_SEC01_NURS2020/Heаrt Sоund f1.m4а Heаrt Sound _______ You auscultate the Mr. Carter's heart while he is positioned in the left lateral decubitus position, using the bell of your stethoscope at the cardiac apex. Listen to the accompanying audio recording and identify the abnormal heart sound. Identify the heart sound listed above. (Normal, S3, S4, Murmur, Friction Rub)

Reаd the fоllоwing cаse scenаriо, as documented in a "SO"AP format. Then follow the directions. Chief Complaint "I've been getting headaches more often, and I just don't have the energy I used to." History of Present Illness James Carter is a 63-year-old White male who presents to a community health clinic with complaints of frequent headaches and increasing fatigue over the past three months. He states the headaches occur several times each week, are typically located in the back of his head, and are most noticeable after working long days. He has also noticed becoming short of breath while laying brick, carrying bags of mortar, or climbing scaffolding at work. He attributes his symptoms to "just getting older." Mr. Carter reports occasional swelling in both ankles at the end of the workday that improves overnight after resting. He denies chest pain, palpitations, dizziness, syncope, fever, chills, cough, wheezing, calf pain, or recent illness. He states that he has never established care with a primary healthcare provider: "I don't have insurance, so I just deal with things unless they're bad enough that I can't work." He recalls being told during a pre-employment physical approximately eight years ago that his blood pressure was elevated and that he should see a healthcare provider for further evaluation. Because he was asymptomatic, uninsured, and concerned about the cost of medical care, he did not seek follow-up. He has not had routine medical care or blood pressure monitoring since that time. Past Medical History No known chronic medical conditions No previous surgeries No prior hospitalizations Current Medications Ibuprofen 400 mg by mouth most evenings after work for chronic back and knee pain Allergies No known drug allergies Family History Father died from a myocardial infarction at 58 years of age. Mother had hypertension and died following a stroke in her early 70s. Older brother has hypertension and type 2 diabetes mellitus. Social History Mr. Carter graduated from high school. He has worked as a masonry laborer for more than 40 years. His job requires frequent heavy lifting, climbing scaffolding, kneeling, and prolonged standing. He lives alone in a rented mobile home and does not have health insurance. He reports avoiding routine healthcare because of the cost. He currently smokes 1½ packs of cigarettes per day and has smoked since age 18. He drinks 4 to 6 beers most evenings after work and often consumes more on weekends while watching sports on television. (Negative CAGE).  He denies illicit drug use. Because of his work schedule and financial situation, he frequently eats fast food, canned soups, frozen meals, and other processed foods. He reports getting little formal exercise outside of work because he is exhausted by the end of the day. Review of Systems Constitutional:Reports fatigue. Denies fever, chills, or unintentional weight loss. Cardiovascular:Reports bilateral ankle swelling by the end of the day. Denies chest pain, palpitations, or syncope. Respiratory:Reports shortness of breath with moderate exertion. Denies cough, wheezing, orthopnea, paroxysmal nocturnal dyspnea, or hemoptysis. Neurologic:Reports intermittent occipital headaches. Denies dizziness, weakness, numbness, vision changes, or speech difficulty. All other systems reviewed and are negative. Physical Examination Vital Signs Blood Pressure: 178/98 mmHg, right arm, seated Repeat Blood Pressure (after 5 minutes): 174/96 mmHg Heart Rate: 86 beats/minute, regular Respiratory Rate: 18 breaths/minute Temperature: 98.2°F (36.8°C) Oxygen Saturation: 97% on room air Height 5 ft 10 in (178 cm) Weight 198 lb (90 kg) BMI 28.4 kg/m² General Appearance Alert, cooperative male who appears older than his stated age. He is appropriately dressed and in no acute distress. His skin is weathered with evidence of chronic sun exposure. A noticeable odor of tobacco is present. Cardiovascular Regular rate and rhythm. Normal S1 and S2 are present. A low-pitched extra heart sound is auscultated immediately following S2 and is best heard with the bell of the stethoscope at the cardiac apex while the patient is positioned in the left lateral position. No murmurs are heard. Peripheral pulses are 2+ and symmetric bilaterally. Capillary refill is less than 2 seconds. Respiratory Thorax symmetric with normal respiratory effort. Breath sounds are clear to auscultation bilaterally. No wheezes, crackles, or rhonchi are appreciated. Peripheral Vascular Trace bilateral pitting edema is present at both ankles. Lower extremities are warm with appropriate skin color. No cyanosis or clubbing is noted. No calf tenderness is present. Neurologic Alert and oriented to person, place, time, and situation. Speech is clear. No focal neurologic deficits are observed. ------------------------------------------------------- Written Response Question Based on James Carter’s history and physical examination findings, as listed above in the SOAP note, identify your top three differential diagnoses. In your response: Identify three appropriate differential diagnoses in order of priority. Explain the subjective and objective findings supporting each diagnosis. Describe how the patient's history, cardiovascular risk factors, and physical examination findings contribute to your clinical reasoning. Directions Respond in 3–4 well-developed paragraphs using in-text citations when needed. Course textbook(s), course lecture notes, and course content are the only resources allowed for this assignment. A reference page is not required. Your response should demonstrate advanced clinical reasoning based on the patient’s cardiovascular, peripheral vascular, and lymphatic assessment findings, including interpretation of heart sounds, blood pressure readings, peripheral perfusion findings, and relevant historical risk factors. *Please see the attached rubric.

Reаd the fоllоwing cаse scenаriо, as documented in a "SO"AP format. Then follow the directions. Patient Information Name: Emily LawsonAge: 34 yearsSex: Female Race: WhiteOccupation: Elementary school teacherMarital Status: MarriedInsurance: Blue Cross Blue Shield of TN Chief Complaint (CC) "I've had migraines for years, but lately they're happening more often." History of Present Illness (HPI) Emily Lawson is a 34-year-old female who presents to establish care for worsening headaches. She reports a history of migraine headaches beginning in college, but states that over the past four months the headaches have become more frequent. Previously, she experienced one migraine every two to three months; however, she now experiences approximately two to three headaches per month. She describes the headaches as a throbbing pain that typically begins behind her left eye and spreads to the left side of her head. The pain is usually rated as 8/10 and lasts approximately 12–24 hours if untreated. She reports associated nausea, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). She prefers to lie in a dark, quiet room until the headache resolves. She denies experiencing an aura before the headaches. Emily reports that the headaches often occur around the time of her menstrual cycle and seem to be triggered by increased stress at work, inadequate sleep, and occasionally skipping meals. She has been taking over-the-counter ibuprofen with some relief but feels that it is becoming less effective. She estimates taking ibuprofen approximately 4–5 days per week over the past two months because of frequent headaches. She denies fever, chills, recent head trauma, neck stiffness, seizures, weakness, numbness, tingling, difficulty speaking, vision loss, loss of consciousness, gait instability, or recent illness. Emily states she is becoming increasingly concerned because her mother died from a brain tumor several years ago. "I know I've always had migraines, but now I'm worried something more serious could be causing these headaches." Past Medical History Migraine headaches Seasonal allergic rhinitis Gynecologic History LMP: 10 days ago Menstrual cycles occur every 28–30 days, lasting 4–5 days with moderate flow. Reports that headaches frequently occur 1–2 days before the onset of menses or during the first day of her menstrual period. Gravida 2, Para 2. Husband has had a vasectomy (or, alternatively, uses oral contraceptives if you want to discuss estrogen-containing contraception and migraine in a future course). Denies current pregnancy.     Past Surgical History Cesarean section ×2     Medications Ibuprofen 400 mg as needed for headaches (reports using 4–5 days/week) Cetirizine 10 mg daily during allergy season Daily multivitamin     Allergies No known drug allergies (NKDA) Family History Mother: Deceased at age 58 from glioblastoma Father: Hypertension and hyperlipidemia Sister: Migraine headaches Maternal grandmother: Type 2 diabetes mellitus Social History Emily is married and lives with her husband and two young children. She works full-time as an elementary school teacher and describes her job as rewarding but increasingly stressful. She denies tobacco or illicit drug use. She drinks one to two glasses of wine on weekends and consumes approximately three cups of coffee daily. She exercises by walking several days each week but reports decreased physical activity because of her headaches. She sleeps approximately five to six hours per night and frequently wakes feeling unrefreshed. Review of Systems General Reports fatigue. Denies fever, chills, or unexplained weight loss. HEENT Reports recurrent unilateral headaches, photophobia, phonophobia, and nausea during headaches. Denies vision loss, diplopia, hearing loss, tinnitus, nasal congestion, sore throat, or dysphagia. Cardiovascular Denies chest pain, palpitations, syncope, or edema. Respiratory Denies cough, dyspnea, or wheezing. Gastrointestinal Reports nausea associated with headaches. Denies vomiting, abdominal pain, diarrhea, or constipation. Neurological Reports recurrent headaches. Denies dizziness, seizures, weakness, numbness, paresthesias, tremors, speech changes, balance problems, or loss of consciousness. Musculoskeletal Reports occasional neck and shoulder tightness after prolonged computer work. Denies joint pain, muscle weakness, or recent injury. Psychiatric Emily reports increased stress related to work and family responsibilities but denies persistent sadness, hopelessness, excessive anxiety, panic attacks, or suicidal ideation. A PHQ-9 was administered during today's visit with the following responses: Question Score Little interest or pleasure in doing things 0 Feeling down, depressed, or hopeless 1 Trouble falling asleep, staying asleep, or sleeping too much 2 Feeling tired or having little energy 1 Poor appetite or overeating 0 Feeling bad about yourself 0 Trouble concentrating 1 Moving or speaking slowly or being fidgety/restless 0 Thoughts of being better off dead or self-harm 0 Total PHQ-9 Score: 5 (Mild depressive symptoms) Emily states that her sleep difficulties and fatigue are primarily related to stress and frequent headaches. Vital Signs BP: 118/76 mmHg HR: 74 bpm RR: 16 breaths/min Temperature: 98.4°F (36.9°C) SpO₂: 99% on room air Height: 5'6" (168 cm) Weight: 156 lb (70.8 kg) BMI: 25.2 kg/m² Pain (during visit): 3/10 Physical Examination General Alert, pleasant female in no acute distress. Appears stated age. Maintains appropriate eye contact and answers questions appropriately. Mental Status Alert and oriented to person, place, time, and situation. Speech is clear and fluent. Mood is mildly anxious when discussing her headaches. Affect is appropriate. Thought processes are logical and goal-directed. Memory, attention, concentration, judgment, and insight are intact. HEENT Head normocephalic and atraumatic. Pupils equal, round, and reactive to light and accommodation. Extraocular movements intact. Fundoscopic examination reveals sharp optic disc margins without papilledema. Visual fields intact by confrontation. Cardiovascular Regular rate and rhythm, S1 and S2 present, no murmurs, rubs, or gallops. No carotid bruits auscultated bilaterally. Peripheral pulses 2+ and symmetric. No lower extremity edema. Neurological Cranial nerves II–XII intact. Motor strength 5/5 throughout. Muscle tone normal. Sensation intact to light touch. Deep tendon reflexes 2+ and symmetric. Negative pronator drift. Finger-to-nose and heel-to-shin testing intact. Rapid alternating movements normal. Negative Romberg. Normal gait, including tandem walking. No focal neurological deficits. Musculoskeletal Full active range of motion of the cervical spine and all extremities. Mild tenderness over the bilateral upper trapezius and cervical paraspinal muscles. No spinal tenderness or joint swelling. Strength 5/5 throughout. --------------------------------------------------- Written Response Question Based on Emily Lawson’s history, PHQ-9 screening results, and physical examination findings, identify the diagnostic studies and/or laboratory tests that are appropriate to further evaluate her condition. In your response: Identify the diagnostic studies and/or laboratory tests that are indicated based on Emily’s clinical presentation. Explain the purpose of each diagnostic study or laboratory test. Describe how the results would help confirm or rule out your differential diagnoses, evaluate for potential secondary headache etiologies and neurological “red flags,” and support your clinical reasoning and diagnostic decision-making. If diagnostic testing is not indicated at this time, explain your rationale using the patient’s history and physical examination findings. Directions Respond in 2–3 well-developed paragraphs using evidence-based clinical reasoning and appropriate medical terminology. Provide in-text citations to support your rationale when appropriate. Course textbook(s), course lecture notes, and course content are the only resources permitted for this assignment. A reference page is not required. Your response should demonstrate advanced clinical reasoning based on the patient’s neurological, mental health, and musculoskeletal assessment findings, including interpretation of the PHQ-9 screening results, headache characteristics and associated symptoms, neurological examination findings, and identification of any findings that may suggest secondary headache disorders. Please see the attached rubric.

Reаd the fоllоwing cаse scenаriо, as documented in a "SO"AP format. Then follow the directions. Patient Information Name: Emily LawsonAge: 34 yearsSex: Female Race: WhiteOccupation: Elementary school teacherMarital Status: MarriedInsurance: Blue Cross Blue Shield of TN Chief Complaint (CC) "I've had migraines for years, but lately they're happening more often." History of Present Illness (HPI) Emily Lawson is a 34-year-old female who presents to establish care for worsening headaches. She reports a history of migraine headaches beginning in college, but states that over the past four months the headaches have become more frequent. Previously, she experienced one migraine every two to three months; however, she now experiences approximately two to three headaches per month. She describes the headaches as a throbbing pain that typically begins behind her left eye and spreads to the left side of her head. The pain is usually rated as 8/10 and lasts approximately 12–24 hours if untreated. She reports associated nausea, sensitivity to light (photophobia), and sensitivity to sound (phonophobia). She prefers to lie in a dark, quiet room until the headache resolves. She denies experiencing an aura before the headaches. Emily reports that the headaches often occur around the time of her menstrual cycle and seem to be triggered by increased stress at work, inadequate sleep, and occasionally skipping meals. She has been taking over-the-counter ibuprofen with some relief but feels that it is becoming less effective. She estimates taking ibuprofen approximately 4–5 days per week over the past two months because of frequent headaches. She denies fever, chills, recent head trauma, neck stiffness, seizures, weakness, numbness, tingling, difficulty speaking, vision loss, loss of consciousness, gait instability, or recent illness. Emily states she is becoming increasingly concerned because her mother died from a brain tumor several years ago. "I know I've always had migraines, but now I'm worried something more serious could be causing these headaches." Past Medical History Migraine headaches Seasonal allergic rhinitis Gynecologic History LMP: 10 days ago Menstrual cycles occur every 28–30 days, lasting 4–5 days with moderate flow. Reports that headaches frequently occur 1–2 days before the onset of menses or during the first day of her menstrual period. Gravida 2, Para 2. Husband has had a vasectomy (or, alternatively, uses oral contraceptives if you want to discuss estrogen-containing contraception and migraine in a future course). Denies current pregnancy.     Past Surgical History Cesarean section ×2     Medications Ibuprofen 400 mg as needed for headaches (reports using 4–5 days/week) Cetirizine 10 mg daily during allergy season Daily multivitamin     Allergies No known drug allergies (NKDA) Family History Mother: Deceased at age 58 from glioblastoma Father: Hypertension and hyperlipidemia Sister: Migraine headaches Maternal grandmother: Type 2 diabetes mellitus Social History Emily is married and lives with her husband and two young children. She works full-time as an elementary school teacher and describes her job as rewarding but increasingly stressful. She denies tobacco or illicit drug use. She drinks one to two glasses of wine on weekends and consumes approximately three cups of coffee daily. She exercises by walking several days each week but reports decreased physical activity because of her headaches. She sleeps approximately five to six hours per night and frequently wakes feeling unrefreshed. Review of Systems General Reports fatigue. Denies fever, chills, or unexplained weight loss. HEENT Reports recurrent unilateral headaches, photophobia, phonophobia, and nausea during headaches. Denies vision loss, diplopia, hearing loss, tinnitus, nasal congestion, sore throat, or dysphagia. Cardiovascular Denies chest pain, palpitations, syncope, or edema. Respiratory Denies cough, dyspnea, or wheezing. Gastrointestinal Reports nausea associated with headaches. Denies vomiting, abdominal pain, diarrhea, or constipation. Neurological Reports recurrent headaches. Denies dizziness, seizures, weakness, numbness, paresthesias, tremors, speech changes, balance problems, or loss of consciousness. Musculoskeletal Reports occasional neck and shoulder tightness after prolonged computer work. Denies joint pain, muscle weakness, or recent injury. Psychiatric Emily reports increased stress related to work and family responsibilities but denies persistent sadness, hopelessness, excessive anxiety, panic attacks, or suicidal ideation. A PHQ-9 was administered during today's visit with the following responses: Question Score Little interest or pleasure in doing things 0 Feeling down, depressed, or hopeless 1 Trouble falling asleep, staying asleep, or sleeping too much 2 Feeling tired or having little energy 1 Poor appetite or overeating 0 Feeling bad about yourself 0 Trouble concentrating 1 Moving or speaking slowly or being fidgety/restless 0 Thoughts of being better off dead or self-harm 0 Total PHQ-9 Score: 5 (Mild depressive symptoms) Emily states that her sleep difficulties and fatigue are primarily related to stress and frequent headaches. Vital Signs BP: 118/76 mmHg HR: 74 bpm RR: 16 breaths/min Temperature: 98.4°F (36.9°C) SpO₂: 99% on room air Height: 5'6" (168 cm) Weight: 156 lb (70.8 kg) BMI: 25.2 kg/m² Pain (during visit): 3/10 Physical Examination General Alert, pleasant female in no acute distress. Appears stated age. Maintains appropriate eye contact and answers questions appropriately. Mental Status Alert and oriented to person, place, time, and situation. Speech is clear and fluent. Mood is mildly anxious when discussing her headaches. Affect is appropriate. Thought processes are logical and goal-directed. Memory, attention, concentration, judgment, and insight are intact. HEENT Head normocephalic and atraumatic. Pupils equal, round, and reactive to light and accommodation. Extraocular movements intact. Visual fields intact by confrontation. Cardiovascular Regular rate and rhythm, S1 and S2 present, no murmurs, rubs, or gallops. No carotid bruits auscultated bilaterally. Peripheral pulses 2+ and symmetric. No lower extremity edema. Neurological Muscle tone normal. Deep tendon reflexes 2+ and symmetric. Negative pronator drift. Finger-to-nose and heel-to-shin testing intact. Rapid alternating movements normal. Normal tandem walking. No focal neurological deficits. Musculoskeletal Full active range of motion of the cervical spine and all extremities. Mild tenderness over the bilateral upper trapezius and cervical paraspinal muscles. No spinal tenderness or joint swelling. Strength 5/5 throughout. --------------------------------------------------- Written Response Question Based on Emily Lawson's history, PHQ-9 screening results, and physical examination findings, as listed above in the "SO"AP note, identify your top three differential diagnoses and determine the most likely (final) diagnosis. In your response: Identify three appropriate differential diagnoses in order of priority. Identify the most likely (final) diagnosis. Explain the subjective and objective assessment findings that support each differential diagnosis and justify why the final diagnosis is the most likely. Directions Respond in 3–4 well-developed paragraphs using in-text citations when needed. Course textbook(s), course lecture notes, and course content are the only resources allowed for this assignment. A reference page is not required. Your response should demonstrate advanced clinical reasoning based on the patient's mental health, neurological, and musculoskeletal assessment findings, including interpretation of the PHQ-9 screening results, headache characteristics, neurological examination findings, musculoskeletal assessment findings, and relevant historical risk factors. Please see the attached rubric.