PBL Case Discussion Part One (graded)
Setting
: - Family practice clinic that employs physicians and nurse practitioners
Your 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 pox
Chronic illnesses
: None
Surgeries
: cholecystectomy 2 years ago, total abdominal hysterectomy 15 years ago
Hospitalizations
: childbirth x 2
Immunizations
: Does not receive the flu shot.
Allergies
: Penicillin (rash)
Blood transfusions
: None
ETOH, 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 completed
Social 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
