Value: 100 points

Due: Day 7

Gradebook Category: QBank

Please navigate to your APEA learning portal and complete a 20-question practice quiz related to the body system/topics covered this week. You may choose whichever test mode you like. You may complete as many 20-question quizzes as you like to improve your score. Once you are satisfied with your score, please take a screenshot of the quiz score you would like to count and submit to the Moodle dropbox. Please be sure the following are visible in your screenshot:

Week 3 

A 75-year-old patient of Hispanic descent arrives in an immigrant healthcare clinic with fever, chills, a sore throat, and a nonproductive cough. She speaks some English. The patient appears very ill, with dry mucous membranes, dark circles under the eyes, and pale skin. The patient appears anxious and is reluctant to make eye contact or speak. The health history reveals that the patient lives with extended family in a home setting, including infants and elderly. All of the family members are undocumented residents of the United States.
Past Medical History: Hypertension, Asthma.

Family History: Father (Deceased 81 / Stroke); Mother (Alive 95 / HTN, COPD, Diabetes)

Additional questions: 
• How long have you had the cough?
• Have you had been having night sweats or had recent weight loss? (Weinburger, 2022)
• Is your cough constant? Does it keep you up at night?
• Does your chest hurt with your cough?
• Do you feel short of breath? At rest? With normal activity? (Klompas, 2022)
• Do you have any pain with taking a deep breath? Pain in your lungs?
• Have you had a cough like this before?
• Are you taking any medications for your asthma?
• Has anyone else in your family (including children) or home setting been sick recently? (Mody, 2022).
• Do you smoke or does anyone in your household smoke indoors? (Ramirez, 2022)
• Do you have any abdominal pain?
• Have you had recent nausea, vomiting or diarrhea?
• How much fluid are you taking in?
• Have you had recent loss of appetite? (Mody, 2022)
• Have you recently experienced coughing/choking while eating or drinking? (Klompas, 2022).

1. Your name
2. Date (must be completed in the week it is due)
3. Number of questions completed
4. Topics questions came from
5. Overall score

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Submission status

Submission status	Submitted for grading
Grading status	Graded
Time remaining	Assignment was submitted 11 days 1 hour early
Last modified	Wednesday, 18 January 2023, 10:02 PM
File submissions	Respiratory test.pdfTurnitin ID: 199514133886%18 January 2023, 10:02 PM
Submission comments	Comments (0)

iHuman Moodle Rubric

Criteria	Exceeds Expectations	Meets Expectations	Needs Improvement	Inadequate	Total Points
Subjective – 40%	Determined by iHuman 40 points	Determined by iHuman 36 points	Determined by iHuman 32 points	Determined by iHuman 0 points	40
Objective – 25%	Determined by iHuman 25 points	Determined by iHuman 22 points	Determined by iHuman 20 points	Determined by iHuman 0 points	25
Objective – 5% (Testing)	Determined by iHuman 5 points	Determined by iHuman 4 points	Determined by iHuman 3 points	Determined by iHuman 0 points	5
Assessment—5%	Three differential diagnoses are supported by findings and include worst-case scenario. Rationale for differential diagnoses provided by scholarly resources. 5 points	Three differential diagnoses include worst-case scenario, but one diagnosis might not be fully supported by findings. Rationale for differential diagnoses provided by scholarly resources. 3 points	Differential diagnoses may or may not include worst-case scenario, and two differential diagnoses are not supported by findings. Rationale for all differential diagnoses not provided by scholarly resources. 1 points	Fewer than three differential diagnoses identified, or differential diagnoses not supported by findings and do not include worst-case scenario. Scholarly resources not provided or do not support differential diagnoses. 0 points	5
Plan—25%	Comprehensive plan includes all components: Diagnostic testing Pharmacologic intervention Non-pharmacologic intervention Referrals Patient education Follow-up Appropriate and current guidelines cited. 25 points	Plan missing one of the identified components: Diagnostic testing Pharmacologic intervention Non-pharmacologic intervention Referrals Patient education Follow-up Appropriate and current guidelines cited. 17 points	Plan missing two of the identified components: Diagnostic testing Pharmacologic intervention Non-pharmacologic intervention Referrals Patient education Follow-up Guidelines are not current or appropriate for identified problem. 9 points	Plan missing more than three of the identified components: Diagnostic testing Pharmacologic intervention Non-pharmacologic intervention Referrals Patient education Follow-up Guidelines for plan not cited. 0 points	25
Total Points					100

Week 1 Discussion 1: Telehealth/Transgender

HPI: An otherwise healthy 35-year-old transgender woman on hormone suppressant therapy presents with a chief complaint of sinus congestion and runny nose that began 2 days ago. She tells you that her sinus infections always start off this way, and she has a wedding to go to this coming weekend and does not want to be sick for this event. She is requesting antibiotics and is quite insistent that she requires this treatment.

The additional questions of subjective information that I would ask the patient in order to develop the differential diagnoses and plan would include the following:

1.     Have you experienced a sore throat or pain with swallowing?

2.     Have you had any signs of swollen lymph nodes along the side of your neck or underneath the area of your chin?

3.     Have you experienced any yellow crusted drainage from your eyes?

4.     Do you experience tinnitus; a ringing or buzzing sound in your ears? Rhee et al., (2020) conducted a research study which revealed that patients with a medical history of ear infections and sinusitis was directly related to, and a high-risk factor for developing tinnitus; which in fact, these patients had significant hearing loss concurrently with an infection.

5.     Do you feel pressure or pain when you touch your cheeks or forehead?

6.     Do you experience any changes to the tone of your voice or hoarseness?

7.     Do you experience or have had a history of postnasal drip?

8.     Do you experience any eye pain or pressure behind your eyes?

9.     Have you experienced epistaxis or nosebleeds?

10.  Have you ever injured or required surgery to the nasal septum?

11.  Have you ever been diagnosed with having a deviated nasal septum? Alsaggaf et al., (2022) discussed the incidence of deviated nasal septum being associated with the occurrence of sinusitis; in which approximately 75.1% of study participants reported developing sinusitis from a deviated nasal septum.

References

Alsaggaf, Z.H., Almadfaa, A.O., Marouf, A.A., Alfawaz, K.S., Niyazi, R.A., Ibrahim, N.K., & Ajlan, A.M. (2022). Sinusitis and its association with deviated nasal septum at a tertiary hospital: A retrospective study. Journal of Taibah University Medical Sciences, 17(6), 1065-1069. https://doi.org/10.1016/j.jtumed.2022.06.001

Rhee, J., Lee, D., Suh, M.W., Lee, J.H., Hong, Y.C., Oh, S.H., & Park, M.K. (2020). Prevalence, associated factors, and comorbidities of tinnitus in adolescents. Plus One, 15(7): e0236723. https://doi.org/10.1371/journal.pone.0236723