Week 6 case study

Bertha, a 58 – year – old Hispanic female, presents to the primary care clinic to establish care. She states that in 1985 she received a blood transfusion after sustained an MVA. She had tested positive for hepatitis C virus ( HCV ) in the past, but ignored any advice regarding treatment options. She brings a previous lab result with her today that shows :(ALT) level of 85 IU/mL (range 8 – 35 IU/mL). The lab form also states, “ HCV antibody is positive by enzyme immunoassay — confirmation is suggested. The patient also arrived with diagnosis with exacerbation of A-Fib (pulse 110 beats per mint. and COPD exacerbation as well (O2 sat: 87%)

Past medical h story: Hypertension, dyslipidemia, hepatitis C.

Family history: Unremarkable

Social history: She works as a case manager of an HMO and is married with 2 children. Denies use of illegal drugs, denies alcohol abuse, and has no tattoos.

Medications: HCTZ, 12,5 mg daily; Atorvastatin 20 mg daily, Metoprolol Succinate 25 mg and Pro-Air HFA 90mcg one puff q 4- 6 hrs as needed x pain.

Allergies: No known drug or food allergies.

OBJECTIVE General a ppearance: 58 – year – old female; pleasant, in no acute distress; good eye contact. Vital signs: T: 96.8; P: 110; RR: 23; SaO 2 : 87; BP: 150/100. Her weight is 214 lb, and her height is 6.3 inches.

HEENT : Negative. Neck: Thyroid nonpalpable. No lymphadenopathy.

Cardiovascular: A-fib rhythm. irregular and rapid heartbeat.

Respiratory: Crackles and Wheezing.

Abdomen: Mild tenderness in right upper quadrant. BS x 4 no bruits. Nondistended, soft. No organomegaly. No ascites.

Neurological: A & O × 4, CN II – XII grossly intact.

Depression scale: negative. Musculoskeletal: Full ROM. No deformities. Muscle strength is 5/5.

CRITICAL THINKING

Which diagnostic or imaging studies should be considered confirm the

diagnosis?

What is the most likely differential diagnosis?

What is your plan of treatment?

Are there any emergency referrals needed?

What is first line treatment for AFib in patients with the mentioned comorbidities?

What is the first line of treatment for COPD exacerbation?

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