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PBL Case Discussion Part One (graded)Setting: - Family practice clinic that employs physicians and nurse practitionersYour next patient is new to the practice, a 50-year-old woman with fatigue x three weeks. The chart holder is empty except for a cover sheet.You enter the room and see a well-dressed woman sitting on the exam table. She smiles when you enter. You introduce yourself as you always do and ask what brings her to the clinic today.Jessica says, “I have been feeling lousy for the last few weeks. I thought it was stress at work or maybe a cold coming on but it’s not getting better with rest and a vacation. I am nauseous, sick to my stomach and my skin looks yellow. ”HPI: Jessica reports decreased appetite and nausea for about three weeks. She states she has lost five pounds. She reports aching muscles and stomach pain on her right side, under her ribs. She has taken Ibuprofen for the aches and pains and finished an old Vicodin script she had from an ankle sprain eight weeks ago.PMHx: Reports general health as good. Was exercising regularly and very active until onset of these symptoms.Childhood/previous illnesses: chicken poxChronic illnesses: NoneSurgeries: cholecystectomy 2 years ago, total abdominal hysterectomy 15 years agoHospitalizations: childbirth x 2Immunizations: Does not receive the flu shot.Allergies: Penicillin (rash)Blood transfusions: NoneETOH, tobacco, illicit drugs. She drinks alcohol socially, does not smoke, denies illicit drug use.Sleeps 6 to 8 hours per night.Current medications: daily multivitamin, fish oil, and CoQ 10, prn Vicodin completedSocial History: Widowed four years ago, dating for one year. Recently joined a social dating website, and has been sexually active with three partners in the past six months. Does not use condoms, had a tubal ligation 15 years ago.Family Hx: Parents are alive in good health. She has two daughters in good health.Discussion Questions Part One:List any further questions you have for Jessica according to each diagnosis in your differential list.
What are the three to five most common differential diagnoses for this visit thus far with pathophysiology and evidence-based rationale? Please include the pertinent info from the case