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NRNP 6568 iHuman Case Study, Exams of Advanced Education

NRNP 6568 iHuman Case Study NRNP 6568 iHuman Case Study

Typology: Exams

2024/2025

Available from 04/15/2025

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MarvindWebster
History
HowdcandIdhelpdyoudtoday?
Dodyoudhavedanydotherdsymptomsdordconcernsdwedshouldddiscuss?
Dodyoudhavedanydallergies,dsuchdasdmedications,dfooddand/ordlatex,dfordexample?dAred
youdtakingdanydprescriptiondmedications?
Aredyoudtakingdanydover-the-counterdordherbaldmedications?
Candyoudtelldmedaboutdanydcurrentdordpastdmedicaldproblemsdyoudhavedhad?dAnyd
previousdmedical,dsurgical,dorddentaldprocedures?
Dodyoudnowdordhavedyoudeverdsmokeddordcheweddtobacco?dH
avedyoudhaddanydcontactdwithdotherdsickdpeople?
Aredyoudsexuallydactive?
Dodyoudexperience:dchestdpainddiscomfortdordpressure;dpain/pressure/dizzinessdwithdexertiondordget
tingdangry;dpalpitation;ddecreaseddexercisedtolerance;dblue/colddfingersdordtoes?
Dodyoudhavedanydofdthedfollowing:ddizziness,dfainting,dspinningdroom,dseizures,dweakness,dnumbness
,dtingling,dtremor?
Dodyoudhavedanydofdthedfollowingdproblems:dfatigue,ddifficultydsleeping,dunintentionaldweightdlossdor
dgain,dfevers,dnightdsweats?
Howdhighdwasdyourdfever?
Whendyoudurinate,dhavedyoudnoticed:dpain,dburning,dblood,ddifficultydstartingdordstopping,ddribbling
,dincontinence,durgencydduringddaydordnightdordanydchangesdindfrequency?
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MarvindWebster

History HowdcandIdhelpdyoudtoday?

Dodyoudhavedanydotherdsymptomsdordconcernsdwedshouldddiscuss? Dodyoudhavedanydallergies,dsuchdasdmedications,dfooddand/ordlatex,dfordexample?dAred youdtakingdanydprescriptiondmedications?

Aredyoudtakingdanydover-the-counterdordherbaldmedications? Candyoudtelldmedaboutdanydcurrentdordpastdmedicaldproblemsdyoudhavedhad?dAnyd previousdmedical,dsurgical,dorddentaldprocedures? Dodyoudnowdordhavedyoudeverdsmokeddordcheweddtobacco?dH

avedyoudhaddanydcontactdwithdotherdsickdpeople?

Aredyoudsexuallydactive? Dodyoudexperience:dchestdpainddiscomfortdordpressure;dpain/pressure/dizzinessdwithdexertiondordget

tingdangry;dpalpitation;ddecreaseddexercisedtolerance;dblue/colddfingersdordtoes? Dodyoudhavedanydofdthedfollowing:ddizziness,dfainting,dspinningdroom,dseizures,dweakness,dnumbness ,dtingling,dtremor?

Dodyoudhavedanydofdthedfollowingdproblems:dfatigue,ddifficultydsleeping,dunintentionaldweightdlossdor dgain,dfevers,dnightdsweats? Howdhighdwasdyourdfever? Whendyoudurinate,dhavedyoudnoticed:dpain,dburning,dblood,ddifficultydstartingdordstopping,ddribbling

,dincontinence,durgencydduringddaydordnightdordanydchangesdindfrequency?

Howdsevered(1- 10)disdthedpaindindyourdchest?dDodyoudhavedanyd

paindindyourdchest? Havedyoudnoticed:danydbruising,dbleedingdgums,dnosedbleedsdordotherdsitesdofdincreaseddbleeding?

Dodyoudhavedanydofdthedfollowing:dheatdordcolddintolerance,dincreaseddthirst,dincreaseddsweating,dfre quentdurination,dchangedindappetite? Dodyoudhavedanydproblemsdwith:dnervousness,ddepression,dlackdofdinterest,dsadness,dmemorydloss,d

ordmooddchanges,dordeverdheardvoicesdordseedthingsdthatdyoudknowdarednotdthere? Dodyoudawakendatdnightdcoughing? Whatdtreatmentsdhavedyoudhaddfordyourdcough? Whatdaredthedeventsdsurroundingdthedstartdofdyourdcough?dIsd

theredanydpatterndtodyourdcough? Doesdanythingdmakedyourdcoughdbetterdordworse?dD odyoudhavedHIV?

Dodyouddrinkdalcohol?dIfdso,dwhatddodyouddrinkdanddhowdmanyddrinksdperdday? Havedyoudhaddadcoughdlikedthisdbefore? Dodyoudhavedproblemsdwith:dnausea,dvomiting,dconstipation,ddiarrhea,dcoffeedgroundsdindyourdvomi t,ddarkdtarrydstool,dbrightdreddblooddindyourdboweldmovements,dearlydsatiety,dbloating?

Dodyoudusedrecreationalddrugs?dIfdso,dwhat? Dodyoudhavedproblemsdwith:dmuscledordjointdpain,dredness,dswelling,dmuscledcramps,djointdstiffnes s,djointdswellingdordredness,dbackdpain,dneckdordshoulderdpain,dhipdpain?

Vitals:dblooddpressuredAbdo men:dpalpatedabdomen

Genitourinary:dgenitourinarydmaledexamd HEENT:dinspectdmouth/pharynxdLympha tic:dpalpatedalldlymphdnodesdMusculoskel

etal:dtestdstrength Neck:dpalpatedneckdNeurolog ical:dcranialdnerves

Neurological:dreflexesd– ddeepdtendondOrthostaticdblooddpress ured(BP)dSPO

Mentaldstatus

MarvindWebster

Chiefdcomplaint: Problems:dfeelsdawfuldanddexhausted,dhasdbodydachesdanddfeelsdreallydweak.dSoredthroat,dcoughing,d anddhasdadheadache.dMuscledachesdtoo

ChiefdcomplaintdSx/Sxdcharacteristicsdquestionsdmissed:

  • Howdbaddisdyourdcough?
  • Doesdanythingdmakedyourdcoughdbetterdordworse?
  • Whatdaredthedeventsdsurroundingdthedstartdofdyourdcough?

AssociateddSx/Sxdcharacteristicsdquestionsdmissed:

  • Dodyoudwheeze?
  • Whatdtreatmentsdhavedyoudhaddfordyourdsoredthroat?
  • Havedyoudhaddadsoredthroatdlikedthisdbefore?

RiskdfactorsdPMHdquestionsdmissed:

  • AredyoudtakingdanydOTCdordherbaldmeds? Etiologydquestionsdmissed:
  • Havedyoudhaddanydcontactdwithdotherdsickdpeople?

HPI/ROSdquestionsdmissed:

isdsuspecteddMarvindhasdthedfludaccordingdtodhisdreporteddsymptoms.dThedCDCd(2020)dreportsdthedflud isdhighlydcontagiousdanddcandbedcontagiousdfordupdtodaddaydbeforedadpatientdevendshowsdsymptoms.dItdi sdimportantdtodinquiredaboutdsymptoms;dweightdloss,ddiarrhea,dduration,dfatiguedanddvaccinedhistorydt odhelpdaidedindaddifferentialddiagnosis.dAskingdMarvindaboutdhisdhealthdhistory,dpriordfludvaccinesdand dhisdsocialdhistorydcandhelpdfurtherddeterminedaddiagnosis. PhysicaldExamdRationale Adfocuseddanddsystematicdphysicaldexamdisdonedofdthedmostdvitaldcomponentsdinddiagnosingda nddtreatmentdofdadpatient.dPerformingdadheaddtodtoedassessmentdanddvitaldsignsdcandbedcrucialdtodidenti fyingdpotentialdproblems.dStartingdwithdMarvin’sdbaselinedvitalsdanddidentifyingdhisdelevateddtemper aturedisdindicativedofdandinfection.dWhiledlisteningdtodMarvin’sdheart,dlungsdanddabdomendadditionaldi nsightdcandbedobserveddanddpalpateddregardingdhisdcardiacdanddgastrointestinaldstatus.dPlayingdclosed attentiondtodauscultationdofdMarvin’sdcoughdcandbetterdidentifydifdthedcoughdisdindthedupperdordlowerdai rwaysdanddcandruledoutdasthmadanddwheezingdwhichdMarvindhaddasdadchild.dItdisdimportantdtodruledoutd possibledupperdrespiratorydinfectionsdwhiledexaminingdthedHEENTdsystem.dMarvin’sdHEENTdexamd findingsdarednegative.dBickleydetdald(2017)dindicatesdauscultatingdlungdsoundsdfordfremitus,degophon ydordbronchophonydcandaidedindtheddeterminingdaddifferentialddiagnosis.d Oftendtimesdinfluenzadcandca usedstomachdpaindleadingdtoddiarrheadwhichdwoulddbedfounddwithdhyperactivedboweldsounds.dMarvin ’sdboweldsoundsdupondpalpationdanddauscultationdaredhoweverdnegative. CasedEvaluation Mydoveralldcasedevaluationdrevealeddareasdofdgrowthdanddopportunitydtodimprovedmydassess mentdanddphysicaldexamdskills.dItdisdimportantdtodfollowdthedheaddtodtoedapproachdtodbedconsistentdand dtodnotdskipdordrepeatdexamsdanddinterviewdquestions.dEnsuringdtodincludedseverity

ofdchiefdcomplaintdfollowingdthedPOLDCARTSdacronymdduringdthedHPI.dNotdtodforgetdtodgodfurtherd indmydassessmentdanddaskdquestionsdpertainingdtodthedpatient’sdsoredthroatdsuchdasdseverity,dtiming,dan ddwhatdmakesdisdbetterdordworse.dOtherdassessmentsdmisseddincludedquestionsdregardingdwheezing,dse veritydanddrelateddproblemsdsuchdasddifficultydsleeping,ddizzinessdordseizures. Overall,dIdneeddtodpracticedsimulationdexercisesdtodbecomedmoredproficientdanddspecificdtodthedbodyd systemsdinvolveddforddiagnosticdanddtreatmentdpurposes.dIdwasdhappydtodseedIdhaddthedsamed“keydfin dings”dasdthedexpertdfeedback.dAlthoughdIdusedddifferentdwording,dthisdweekdIdmanageddtoddodmuchd betterdthisdweek.dAgain,dIdstruggleddtodmakedthedi- Humandsimulationdprogramdhappy.dIdaskeddquestionsdsimilardtodwhatdthedprogramdwanteddmedtodask ,dbutdbecausedIddiddnotdaskdthedexactdquestion,ditdindicatesdIdmisseddaskingdkeydquestions.dSlowingdd own,danddorganizingdmydheaddtodtoedapproachdisdkeydtodnotdmissingdkeydfactorsdsincedthisdsimulatio ndisdnotdbaseddondtimedbutdratherdefficiencydanddaccuracydofdskilldsetdanddcriticaldthinking.dIdalsodnee ddtodpaydcloserdattentiondtodthedamountdofdquestionsdaskeddanddthedqualitydofdeachdquestiondpriordtoda sking.

References

  • coughingdupdyellowdanddgreenishdsputum
  • drinkingorks dhotdteadhelpeddmakedthedcoughdbetterdadlittledindthedbeginningdbutdnodlongerdw
  • nodhemoptysis
  • notdmovingdisdthedonlydthingdthatdhelpsdwithdSOB
  • nodwheezing
  • coughingdmakesdhimdqueasy
  • hxdofdsoredthroatdwithdthedfludbutdnotdnow
  • pain 8 dintercostaldindchestddwhenspace,dcoughingdmidaxillarydordtakingdline) daddeepdbreathd(rightdthorax,d6-
  • nodtightness
  • nodsadness,ddepressiondordhopelessness
  • medicaldhxdofdmilddasthmadasdadchild
  • NKA
  • Nodcurrentdmedicationsdprescribed-takingdOTCdibuprofen
  • Unsuredofdimmunizations
  • Diddnotdgetdthedfludvaccinedordpneumoniadvaccine
  • Nodrecentdtravel
  • Occasionaldbeer
  • Deniesddrugdusedanddsmoking
  • Coughdsyrupdnotdworking
  • Coughingdkeepingdhimd up-dcoughsdwhendgoingdintodthedcold
  • b/ldswollendlymphdnodesdindneck
  • hoarseness

ProblemdStatement MarvindF.dWebsterdisdand18- yeardolddmaledcollegedstudentdwithdadhistorydofdchildhooddasthmadwhodpresentsdwithdacu tedonsetdofdlow- gradedfever,dnonproductivedcough,dsoredthroat,dfatigue,dmyalgiasdanddheadache.dThedph ysicaldexamdrevealsdanderythematousdpharynx,danteriordcervicaldadenopathydanddscattere ddbilateraldcrackles.dRiskdfactorsdincludedlackdofdannualdfludvaccine. Thedarticled“HospitalizeddPatientsdwithd 2009 dH1N1dInfluenzadindthedUniteddStates” statesdthatdhospitalizationdamongdpatientsdwithdinfluenzadisdmoredprevalentdindpatients

65-yearsdofdagedordolderdanddthosedunderdthedagedofd7- yearsdanddyoungdfebriledpatientsdaredmoredlikelydtodbedtesteddfordinfluenzadthandolderdadult sdwithdinfluenzadoftenddodnotdhavedadfever.dThedtypicaldpatientdpresentsdwithdadsuddendons etdofdsymptomsd(fever,dnonproductivedcough,dmyalgias,dheadache,dcoryzadand/ordsoredthro at)d(Jain,dKamimotod&dSchmitz,d2011).d ourdpatientdpresenteddwithdmostdofdthesedsymptom s. Thedhistorydanddphysicaldexaminationdperformeddwasdadfocuseddexamdduedtodthe dpatientdwasdnotdnewdanddrecentlydhaddadphysicaldin.dThedpatientddoesdnotd needdtodbedhospitalizeddduedtodhisdconditiond(Bickley,dSzilagyid&dHoffman, d2017). Thedquestioningdprocessdshoulddflowdfromdgeneraldt odspecific.dStartingdwithdgeneraldquestionsdsuchdas;d“Whatdbringsdyoudindto day?”dYoudcandcontinuedtodaskdopen- endeddquestionsdanddthedflowdintodthedmoredfocuseddquestions.d“Aredyoud havedanydpain,”,d“Whereddoesditdhurt?”,d“candyoudpointdtodthedareadofdyour dheaddthatdhurts? Duringdthedinterviewdavoiddleadingdquestions,dthedgoaldisdtodhavedthedpatie ntddescribedwhatdtheydaredexperiencingd(Bickley,2017).dWhendaskingdques tionsdfordthedreviewdofdsystemsdaskdthedquestionsdasdclosed- dendeddquestiond(yes/no),dindadfocuseddexamdordinterviewditdisdnotdnecessa rydtodaskdalldthedquestionsd(Bickley,d2017).dAnswersdtodthesedquestionsdcan dassistdwithdaddifferentialddiagnosis,dthedpresencedordabsencedofdthesedsym ptomsdwhichdcandleaddtodmoredseriousddiagnosisd(Bickley,d2017).dAdcoupled ofdquestionsdthatdIdmisseddindmydinterviewdwered“aredyoudexperiencingdwh eezing?”dandd“doesdanythingdmakedyourdcoughdbetterdordworse?”dbothdared

whendassessingdthedseveritydofdasthma.dIndMarvin’sdcasedhedwasdfounddtodb edwithoutdsignificantdasthmadexacerbation,ddeniesdshortnessdofdbreathdbu tdwasdnotdtodhavedscattereddcracklesdindthedlowerdbases. Cracklesdmaydbecomed“finer”danddchangedfromdmiddtodlatedinspiratorydduri ngdrecoverydindasthmad(Bickley,d2017).

Thedpatientdhistorydshoulddfocusdonddetectingdsymptomsdconsistentdwithdcommun itydacquireddpneumoniadbecausedpneumoniadcombineddwithdinfluenzadisdth edeighthdleadingdcausedofddeathdindthedUniteddStatesd(Watkinsd &d Lemonovic h,d 2011).d Ford thed focusedd examd Id begand thedexamdwithdthedhead,dears,dno sedanddthroatdbecausedtheydalldlinkeddcloselydtogether.dThedpatientdreporte ddadmilddheadache,dfurtherdinvestigationdisdrecommendeddtodassessdfordlife- threateningdsecondarydcausesd (Bickley,d 2017).d Dued todthed newd complaint d ofdeard pain,dassessingdearsdwithdthedotoscopedwasdnecessarydtodseedifdanyth ingdsignificantdwasdhappening.d IndthedcasedwithdMarvindthedeardfindingsdwer edreddeneddrightdtympanicdmembrane.dThedphysicaldexamdshoulddincludeda ddetaileddexamdofdthedthroatdanddneck,dnotingdanyderythemadordexudate.dTh edpatientdwasdnoteddbilateraldred,derythematousdanddedematousdpharynxd withdtenderd0.8dcmdtod1.0dcmdanteriordcervicaldlymphdnodes.dThesedfindings dalongdwithdlow-gradedfeverdprompteddthedrapiddstrepdtest.

Anotherdareadofdimportancedtodexaminedisdthedabdominaldarea,dnotingdwhetherdt hedabdomendisdsoftdanddwithoutddistention.dAssessingdfor

notabledsplenicdordhepaticdenlargementdordtendernessdisdimportantdduedto dpossibleddiagnosisdofdinfectiousdmononucleosis,dthedpatientdsymptomsdfol lowdthedsimilardsymptomsdofdthisddiseasedwithdfatigue,dfever,dpharyngitisd anddadenopathyd(Porterd&dKaplan,d2011).

Patientsdshoulddbedaskeddaboutdoccupation,danimaldexposures,dtraveldhistorydandd sexualdhistorydtodhelpdidentifydadspecificdinfectiousdagent. Influenzadisdoftendsuggesteddbaseddondtypicaldsymptomsdduringdpeakdinfluen zadseasond(Watkins,d2011).dOurdpatientdisdatdhighdriskdduedtodthedlackdofdrece ivingdthedinfluenzadvaccinedthisdyear.

Maneuveringdthroughdthedprogramdisdstilldmydbiggestdchallenge.dIdhavedimprovedd withdmydscore,dbutditdtookdoverd 200 dquestionsdanddIdstilld missedd 2 dimportantd questionsdtodask.d Idrevieweddthedskilledd interviewingdtechniquesdindchapte rd 3 dofdthedtextbookdanddstilldneeddadlotdofdpracticedwithdmydpatientdintervie w. Idcontinuedtodstruggledwithdthedphysicalde xamdwithdperformingdthemdondthedcomputer,ditdisdmuchdeasierdtodauscultat edondadrealdperson. Idamdhappierdatdthedenddofdthedavatardexa m,dasdmydgradedimproveddeachdtime.

Retrievedd fromd https://www.aafp.org/afp/2011/0601/p1299.html

MarvindWebsterdisdand18-year- olddcollegedstudentdwhodpresentsdwithdadhistorydofdthedfludwhichdresolveddanddthendwasdfolloweddbyd adfour-daydhistorydofdsudden- onset,dfevers,dchills,dshortnessdofdbreath,dfatigue,dpleuriticdchestdpaindanddadproductivedcoughdwitho utdwheezing.dPhysicaldexaminationdisdsignificantdfordadfeverdofd103.2dFd(oral),dtachypnead(rated24/min ),dhypoxia,dRdmiddledanddlowerdlobedcoarsedcracklesdanddtenderdanteriordcervicaldlymphadenopathy.d Heddeniesdknowndsickdcontactsdanddhasdadchildhooddhistorydofdasthmadnowdoffdtherapydwithoutdrece ntdattacks. MarvindWebster Chiefdcomplaint: Problems:dfeelsdawfuldanddexhausted,dhasdbodydachesdanddfeelsdreallydweak.dSoredthroat,dcoughing,d

anddhasdadheadache.dMuscledachesdtoo

ChiefdcomplaintdSx/Sxdcharacteristicsdquestionsdmissed:

  • Howdbaddisdyourdcough?
  • Doesdanythingdmakedyourdcoughdbetterdordworse?
  • Whatdaredthedeventsdsurroundingdthedstartdofdyourdcough?

AssociateddSx/Sxdcharacteristicsdquestionsdmissed:

  • Dodyoudwheeze?
  • Whatdtreatmentsdhavedyoudhaddfordyourdsoredthroat?
  • Havedyoudhaddadsoredthroatdlikedthisdbefore?

RiskdfactorsdPMHdquestionsdmissed:

  • AredyoudtakingdanydOTCdordherbaldmeds? Etiologydquestionsdmissed:
  • Havedyoudhaddanydcontactdwithdotherdsickdpeople?

HPI/ROSdquestionsdmissed:

  • HowdcandIdhelpdyoudtoday
  • Dodyoudhavedanydotherdsymptomsdordconcernsdwedshouldddiscuss
  • Whenddiddthedpaindindyourdchestdstart?
  • Doesdanythingdmakedthedpaindindyourdchestdbetterdordworse
  • Wheredmoredpreciselydisdthedpaindindyourdchest?
  • Doesdthedpaindindyourdchestdradiatedsomeplacedelse?dWhere?
  • Howdsevered1-10dscaledisdthedpaindindyourdchest?d(4-5/10)
  • Havedyoudhaddtraumadtodyourdchest?d–dno
  • Howdlongddoesdyourdchestdpaindlast?
  • Isdyourdchestdpaindprecipitateddbydexercise?
  • Anydchangedindyourdchestdpaindsinceditdbegan?
  • Doesdthedpaindindyourdchestdcomedanddgo?
  • DodyoudexperiencedSOB,dwheezing,ddifficultydcatchingdyourdbreath,dchronicdcough,ds putumdproduction?
  • DodyoudhavedproblemsdwithdN/V,dconstipation,ddiarrhea,dcoffeedgroundsdindyourdvomit,de tc
  • Dodyoudhavedanydofdthedfollowingdproblemsdwith:dfatigue,ddifficultydsleeping,du nintentionaldweightdloss,dordgain,dfevers,dnightdsweats?
  • Dodudhavedanydproblemsdwithdnervousness,ddepression,dlackdofdinterest,dsadness,d memorydloss,dordmooddchanges,detc
  • Dodyouddrinkdalcohol?dIfdso,dwhatddodyouddrinkdanddhowdmanyddrinksdperdday?
  • Hasddrinkingdalcoholdeverdcauseddyoudproblems?
  • Candyoudtelldmedaboutdyourddiet,dwhatdyourdnormallydeat?
  • Havedyoudeverdfeltdyoudneededdtodcutddowndondyourddrinking?
  • Hasdanyonedsuggesteddthatdyoudshoulddreducedthedamountdofdalcoholdyouddrink?
  • Havedyoudeverdbeendannoyeddatdanyonedfordsuggestingdthatdyoudcutdbackdondyourdalcoholdc onsumption?
  • Dodyoudpresentlydhavedheartburn,dadfooddordaciddtastedindyourdmouth?
  • Whendanddwhatddiddyoudlastddrink?d–dwinedaroundd10pmdlastdnight

ChiefdComplaint: “Idfeeldawful...I’mdexhausted,dshortdofdbreath,dmydfeverdisdgettingdworse.”

Musculoskeletal:dPositivedfordmyalgia,dnegativedfordbackdpain,dneckdpaindanddneckdstiffnessdAllergic/I mmunologic:dNegativedfordfooddallergies

Neurological:dNegativedfordseizures,dfacialdasymmetrydanddspeechddifficultydPsychiatric/Behavioral :dNegativedfordconfusion,ddysphoricdmooddanddsleepddisturbance.dThe

patientdisdnotdnervous/anxiousdanddisdnotdhyperactive

PMH:

Childhooddasthma,dnotdcurrentlydunderdtreatment

FMH:

Momd-dHTN

Socialdhx: Collegedstudent,ddeniesdtobaccoduse,dadmitsdtodoccasionaldsocialddrinking,dnotdsexuallydactive,dnodilli citddrugduse

CurrentdMedications: OTCdIbuprofen

OTCdcoughdsyrup

Allergies: Nodknownddrugdallergies

Vitaldsigns:

Temp:d103.2dF Pulse:d 120 dbpmdB P:d120/80dmmHgdR

R:d 24 dbpm O2:d91%dRA

PhysicaldFindings:

General:dAlertdanddorienteddxd4,dcalm,dcooperative

Skin:dpink,dwarmdandddry;dnodrash,dlesionsdordicterus;dtentingdofdtheddorsaldhand

HEENT:dHeaddnormal,datraumatic;dnormaldconjunctiva,dnodscleraldicterus,dcleardrightdanddleftdtympa

nicdmembranes;dexudativedpharyngitis,dnodpalataldpetechiae

Neck:dTenderd1.0-cmdtod1.5-cmdanteriordcervicaldlymphdnodes,dneckdsupple,dfulldrangedofdmotion

Lymphatic:dTenderdanteriordcervicaldadenopathy;dnodposteriordnodesdpalpable;dnodotherdregionaldly mphadenopathy