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2024 New Elisa Hendrick i-Human Case Study New Latest Exam with
Version 100% Correct Verified Answers
Performance Overview for TiwanaHawkinberry on case Elisa
Henderick
The following table summarizes your performance on each section of the case, whether you completed that section or not. Time spent: 3hr 32min 35sec Status: Submitted Case Section Status Your Score Time spent Performance Details History Done 33% (^) 49min 15sec 60 questions asked, 19 correct, 40 missed relative to the case'slist Physical exams Done 65% 14min 1sec 58 exams performed, 14 correct, 1 partially correct, 7 missed relative to the case's list Key findings organization Done (^) 6min 20sec 15 findings listed; 25 listed by the case Problem statement Done (^) 13min 13sec 77 words long; the case's was 165 words Differentials Done 29% (^) 3min 50sec 6 items in the DDx, 2 correct, 5 missed relative to the case's list Differentials ranking Done 71% (lead/alt score) 86% (must not miss score) 1min 31sec Tests Done 14% (^) 33min 0sec 10 tests ordered, 1 correct, 6 missed relative to the case's list Diagnosis Done 100% 12sec Management plan Done (^) 41min 31sec 1346 words long; the case's was 677 words Exercises Done 56% (of scored items only) 10min 22sec 5 of 9 correct (of scored items only)
Attempt: 2678401 Report generated on 3/13/2023, 9:41: AM America/Denver
History Notecard by TiwanaHawkinberry on case Elisa Henderick
Use this worksheet to organize your thoughts before developing a differential diagnosis list.
- Indicate key symptoms ( Sx ) you have identified from the history. Start with the patient's reason(s) for the encounter and add additional symptoms obtained from further questioning.
- Characterize the attributes of each symptom using "OLDCARTS". Capture the details in the appropriate column and row.
- Review your findings and consider possible diagnoses that may correlate with these symptoms. (Remember to consider the patient's age and risk factors.) Use your ideas to help guide your physical examination in the next section of the case. HPI Sx = Sx = Sx = Sx = Sx = Sx = Onset 1 year Location Duration Characteristics Aggravating Relieving Timing / Treatments Severity Attempt: 2678401 Report generated on 3/13/2023, 9:41:
Management Plan by TiwanaHawkinberry on case Elisa Henderick
Primary Diagnosis: Anorexia Nervosa Status/Condition: Guarded Admit to Medicine Green Team Attending: Dr. Who Dunnit Provider Hawkinberry AGAC-NP Code Status: Full Allergies: NKA Admit to Unit: Pediatrics Nursing Orders: Activity Level: Bedrest with Bathroom Privileges Continuous Telemetry with oximetry Peripheral IV Insertion ASAP VTE Prophylaxis Initiated Venodynes to BLE while in bed (DVT prophylaxis) Vital signs q 4 include pain assessment Orthostatic Blood pressures q 4 Daily weight I/O q 8 hr Diet: Regular IV Fluids: 0.9% NaCl bolus xs 1 liter Respiratory: Notify House Officer (In house MD) if spo2 <90% Medications: Hydroxyzine 10mg/5ml Give 12.5 ml q 6 hr Oraxin 0.25 mg/kg/dose three times a day Citalopram 20 mg daily Follow-Up Lab Tests: CBC CMP BMP TSH Liver Enzymes UA/CS Diagnostic testing: ECG ABD Xray Bone density Consults: Mental Health Nutritional management Cardiology (pending ECG) Endocrinology (pending TSH levels) Social Services (follow-up safety/home/community resources) Patient Education and Health Promotion: Diet Medication Orthostasis prevention Stress management/Coping skills Discharge Planning and Required Follow-Up Care: In patient eating disorder treatment program. Follow up with primary care provider within 7 - days or after discharge for Inpatient rehab.
Follow-up Dentist within 7 days or after discharge for Inpatient rehab. Nutrition rehabilitation (Re-feeding nutritional Management) Cognitive behavioral therapy Family based therapy Anorexia nervosa-focused family therapy According to the American Psychiatric Association (APA, 2019 ), people with anorexia nervosa and bulimia nervosa tend to be perfectionists with low self- esteem and are highly critical of themselves and their bodies. Despite life- threatening semi-starvation and malnutrition, they “feel fat” and see themselves as overweight. An intense fear of gaining weight and of being fat may become all-pervasive. Eating disorders often occur with other psychiatric disorders like mood, anxiety, and obsessive-compulsive disorder. PLAN
- Anorexia Nervosa (AN) Goal: 1 - 3 lb weight gain per week Intervention: Inpatient treatment at a Nutritional Rehabilitation program for medical and psychiatric care. To include monitoring for the re-feeding syndrome, electrolyte imbalances, and individual psychotherapy and Cognitive Behavior Therapy (CBT) with the reintegration of socialization skills. CBT is the treatment of choice for AN based on changing dysfunctional thoughts, patterns, attitudes, and beliefs about body image, weight, and control overeating, which are the maintaining factors of the disorder. Given the medical risks associated with symptoms of AN, and the increased risk of a fatal outcome, inpatient and day hospitalization is a widely used treatment for AN (Derenne, 2019).
- Anxiety/Depression Goal: Will report a decrease in depression, anxiety, and OCD as evidenced by improved scores on the PHQ-9, GAD- 7 and Y-BOCS scales within one month of intensive inpatient treatment (Derenne, 2019). Intervention: Inpatient treatment at a Nutritional Rehabilitation program for medical and psychiatric care. According to Peterson & Fuller (2019), patients with Anorexia Nervosa have a high rate of comorbid psychiatric disorders, including depression, anxiety, and obsessionality.
Social hx: 11th grade High School student, who lives with her Mother in a SFH. Participates in volleyball at school and friends are support system. She denies alcohol/drug abuse. Denies sexual activity. ROS: Constitutional: Admits to weight loss. Denies fever, chills, rigors, night sweats, recent illness. HEENT: Denies visual changes, headaches, vertigo, hearing changes, ear pain, sinus problems, difficulty swallowing. Bil parotid enlargement Cardiovascular: Admits to x1 fainting episode. Denies chest pain, or Palpitations. Respiratory: Denies difficulty breathing, shortness of breath, wheezing, difficulty catching breath, chronic cough, sputum production. Gastrointestinal: Admits to self-induced vomiting, and constipation. Denies abdominal pain, diarrhea, coffee ground emesis, dark tarry stools, blood in stools, or bloating. Musculoskeletal: Denies muscle aches, weakness, cramps, joint pain, redness, swelling, back, neck, shoulder or hip pain. Neurological: Denies dizziness, fainting, seizures, numbness, tingling, or tremor. Genitourinary: Denies dysuria, frequency, urgency, or foul smell. Endocrine: Denies excessive thirst, hunger, heat or cold intolerance. Hematologic/Lymphatic: Denies bruising, bleeding or swelling. Psychiatric: Admits to social anxiety and weight related phobia. O Temp 95.9 HR 72 RR 16 BP 98/60 SpO 2 99% RA Height 67 ” inches Weight 100 lbs. BMI 15. GENERAL:A/O x 4, NAD, cachexic, well groomed, slightly anxious SKIN: Cracked lips, mild angular cheilitis, abrasions and calluses on dorsum of right hand HEENT: Head: Normal size and shape for female, no lesions, hair pattern is ethnically appropriate, hair loss, thinning, fine thin hair/lanugo, no rashes. No changes in hearing or vision. Bil ears clear, no redness, infections, wnl. No changes in swallowing or speech, PERRLA, TM’s intact/clear, nasal/oralpharynx clear. Dental erosion. NECK: Bilateral parotid LAD, Thyroid WNL, no nodules CHEST/LUNG: symmetrical rise and fall lungs sounds clear bilaterally HEART: Normal S 1 and S2. No S3, no gallops/rubs Neuro: CN I-XII grossly intact Gastrointestinal: Soft nontender Bs + xs 4 LABORATORY AND DIAGNOSTIC STUDIES: Complete blood count (CBC): Comprehensive metabolic profile (CMP): Thyroid function tests (TFTs): Normal Human chorionic gonadotropin (HCG), urine: Negative EKG: Bradycardic General: AAOx Speech: Soft volume, fluent, normal intonation Psychomotor: Slight psychomotor retardation Mood: Slightly Anxious Affect: Normal Thought content: Denies SI/HI Thought Process: Linear and logical Insight: Poor Judgment: Poor Cognition: Attention intact A
Patient is 16 y/o female who presents to the office at the insistence of her Mother due to weight loss (20 lbs within the last 6 months 30 pounds in lst year). Patient admits to intentionally dieting due to social anxiety and phobia related to the perception of others regarding her weight; and is done using alternating self-restriction of food with binge eating, laxatives use, excessive exercise, and self-induced vomiting. Patient also endorses secondary associated amenorrhea, fatigue, and recent metatarsal stress fracture to her left foot. Parents have been divorced for the past year, and that she is living with Mom. She denies SI/HI. However, she reports loss of interest in usual activities and appears occasionally tearful throughout the exam, but is able to maintain fair eye contact, with low latent speech. There is a self-reported social anxiety and phobia, but denies ever receiving any treatment. On physical exam, patient is noticeable cachexic with fine thinning hair, cracked lips, mild angular cheilitis, bilateral parotid LAD, and abrasions and calluses on the dorsum of her right hand. Laboratory and diagnostics studies are positive for metabolic abnormalities due to self- induced vomiting, use of laxative, and bradycardia. Based on aforementioned information, physical exam, and DSM5 criteria for AN, my main diagnosis is: Anorexia Nervosa with binge eating/purging. Differential diagnoses: Anorexia Nervosa Depression Anxiety, Hyperthyroidism. Attempt: 2678401 Report generated on 3/13/2023, 9:41: AM America/Denver
Category Data entered by Tiwana Hawkinberry Social History no drinking or drugs sexually active no partner denies birth control pills parents are divorced has siblings volleyball/school
Review of Systems
Category Data entered by Tiwana Hawkinberry General Well groomed a/o well spoken agitation noted over appointment, Integumentary / Breast symmetrical HEENT / Neck HEENT no neg finding eomi neg trachea midline no enlarged lymph nodes enlarged parotid glands bil Cardiovascular denies chest pain endorses "fast heart beat" at times Respiratory RR even non labored symmetrical rise and fall Gastrointestinal no changes in b/b bs pos xs r Genitourinary no changes in bladder pattern Musculoskeletal fatigue increase Allergic / Immunologic none Endocrine thyroid unremarkable Hematologic / Lymphatic no brusing Neurologic a/o agitated Psychiatric agitated, anxious of weight
PhysicalExams
Category Data entered by Tiwana Hawkinberry General alert and oriented well groomed verbalization appropriate thinning hair lanugo HEENT unremarkable EOMI neg Skin warm and dry flaky no lesions or wounds no acne HEENT / Neck tracheas midline no enlarged lymph nodes enlarged parotid glands
Cardiovascular denies chest pain endorses "fast heart rate" at times s1/s2 pos Chest / Respiratory symmetrical rise and fall rr even 16 Abdomen bs pos xs 4 Genitourinary / Rectal denies changes in b/b Musculoskeletal / Osteopathic Structural Examination well develop ed muscula r thin Neurologic a/o anxious, agitated at times Psychiatric agitated, anxious, dismissive of weight loss Lymphatic enlarged parotids bil no lymphnodes palpable Attempt: 2678401 Report generated on 3/13/2023, 9:41: AM America/Denver 2024 New Elisa Hendrick i-Human Case Study New Latest Exam with Version 100 Correct Verified Answers2024 New Elisa Hendrick i-Human Case Study New Latest Exam with Version 100 Correct Verified Answers
