course material

1. Analysis of the Differential based on the History and Findings.
Analysis of the Differential based on the History and Findings. Case Study Part OneClients
present chief complaints that might characterize the various condition. Therefore, a
clinician tends to conduct a differential diagnosis to rule out the client's condition. This
paper covers three differential diagnoses conducted on 56-years old female to rule out her
condition. It also summarizes the provided history and the findings of the physical exam.
Finally, it captures additional tests that should be conducted. Analysis of the Differential
based on the History and Findings.ORDER A PLAGIARISM-FREE PAPER HERESummary of
the History and Physical FindingsUpon visiting the clinic on November 7, 2017, the client
who is Caucasian female aged 56 years complains of fatigue. More questions revealed that
the client had been struggling with the condition for 2-3 months. The fatigue was general
and constant. Since its onset, the fatigue had been worsening progressively making her feel
tired most of the time. She did not relax despite sleeping for 8hrs per night. Thus, she was
left with no energy to perform her duties. Nothing had been identified to relieve the pain.
Additionally, no treatment had been prescribed to manage her condition. Depressive
symptoms were reported to be worsening, thus triggering homicidal or suicidal
thoughts.Nonetheless, she denies any pain. In addition to questioning, physical examination
revealed more details regarding her condition. Her temperature was 98.2 while BP was
146/95. Her head was normocephalic and atraumatic. Besides, her skin was overall dry.
Finally, she had an appropriate and pleasant mood.Analysis of the Differential based on the
History and Findings.Differential DiagnosisHypothyroidism (Hashimoto’s
thyroiditis)Hypothyroidism is a disorders that occurs due to the failure of thyroid gland to
secret adequate amount of a particular crucial hormones (Dunphy et al., 2019). The
prevalence of this condition increases due to genetics and environmental factors.
Additionally, the prevalence of Hypothyroidism is relatively high among older women
(Dunphy et al., 2019). Thyroid antigens are attacked by the body resulting in a continuous
cycle of immune response making thyroid follicles to deteriorate with time. This process, in
turn, declines the amount of thyroid hormones, which lowers the overall basal metabolic
rate and other activities in the body (Dunphy et al., 2019).Analysis of the Differential based
on the History and Findings.ObesityThis condition is associated with an imbalance between
caloric intake and energy expenditure(Gadde et al., 2018).This condition is characterized by
weight gain, fatigue in the whole body, decreased energy, and depression (Dunphy et al.,
2019).Analysis of the Differential based on the History and Findings.Stage 2
HypertensionThis condition is associated with a chronic rise in the level of blood pressure.

2. Individuals diagnosed with this condition have a systolic pressure and a diastolic pressure
of 140 mm Hg and 90or high respectively.Analysis of the Differential based on the History
and FindingsHypothyroidism (Hashimoto’s thyroiditis)Positive subjective and objective
findings were reported.Positive subjective findings: Generalized fatigue, 5 lbs weight gain,
mild depression, constipation and generalized weakness.Positive objective findings: Dry
skin and coarse and thick hairNegative findings: No hypersomnia, memory deficits, and
nausea.ObesityBoth positive and negative symptoms were present.Positive subjective
findings: Generalized and constant fatigue, 5 lbs weight gain in the past 6 months, mild
depression, decreased energy, and inability to perform normal duties.Positive objective
findings:Relatively higher BMI, 28.2.Negative findings: Social isolationStage 2
HypertensionPositive subjective findings: Generalized and constant fatigue,Positive
objective findings: High BP, 146/95.Negative findings: Severe headache and vision
problemRanking of the DifferentialHypothyroidismObesityStage 2 HypertensionAdditional
TestsMore tests were required to rule out the client's condition. A blood test in particular
would be conducted to check the level of thyroid hormones and cholesterol in the blood.
According to Lalem et al (2015), the level of cholesterol and triglycerides is relatively high
among individuals struggling with obesity.Three differential diagnosis should be conducted
on this client: Hypothyroidism, obesity, and stage 2 hypertension. It was recommendable to
conduct a blood test to rule client’s condition.Briefly and concisely summarize the history
and physical (H&P) findings as if you were presenting it to your preceptor using the
pertinent facts from the case. Use shorthand where possible and approved medical
abbreviations. Avoid redundancy and irrelevant information.Analysis of the Differential
based on the History and Findings.The patient is a 56 years old Caucasian female with
complaints of generalized fatigue which has been going on for the past 2 to 3 months. The
patient states that it has progressively worsened since onset, feels tired all the time despite
getting 8 hours of sleep per night. She states that she has no energy to do normal activities
that she was able to do in the past. Any exertion makes it worse, and she missed 1 day of
work two weeks ago because she wasn’t able to get out of bed.Analysis of the Differential
based on the History and Findings.The patient denies any fever, chills, or recent illness. ROS
is positive for weight gain of 5lbs since six months ago, constipation, cold intolerance, and
worsening of depressive symptoms due to being “unproductive” lately and feeling tired all
the time. She denies any suicidal or homicidal thoughts. She has generalized weakness and
intermittent muscles cramping in calves.The patient is alert, awake and oriented. She is
pleasant and cooperative. Her BP is 146/95 and other vital signs are stable. Her BMI is
28.2. Her thyroid is midline, small and firm without palpable masses. Her skin is overall
dry, hair coarse and thick, nails without ridging, pitting or discoloration. The rest of her
physical exam is normal.Analysis of the Differential based on the History and
Findings.Medical history of hypertension, depression, and menopause (5 years ago).Surgical
history of tonsillectomy as child.Allergic to Iodine dyes.Medications list: Multivitamin, B-
Complex, Prozac 20mg, Bisoprolol-HCTZ 2.5mg/6.25mg, Calcium 500mg + Vit D3
400IU.Provide a differential diagnosis (minimum of 3) which might explain the patient's
chief complaint along with a brief statement of pathophysiology for each.Analysis of the
Differential based on the History and Findings.Hypothyroidism (Hashimoto’s

3. thyroiditis)Hashimoto’s thyroiditis is an autoimmune condition and a very common cause
of hypothyroidism (Dunphy et al., 2019). This condition tends to form in individuals who
have genetic susceptibility along with environmental aspects. The body attacks its own
thyroid antigens which causes continuous cycle of immune response that leads to
deterioration of thyroid follicles. This results in low levels of thyroid hormones which
decreases overall basal metabolic rate, slows bodily functions, and metabolic processes
(Dunphy et al., 2019).Analysis of the Differential based on the History and Findings.Major
Depressive Disorder (MDD)An individual experiencing negative changes in mood, thinking,
and behavior can be experiencing MDD (Dunphy et al., 2019). The authors discuss a
relationship between depression and increased secretion of cortisol. Genetic factors and
stressful life events also play a huge role in development of MDD. The screening of MDD can
be done by asking patients if they have felt hopeless over the past weeks and if they had
little or no interest in doing things that they used to enjoy doing (Dunphy et al., 2019).
Analysis of the Differential based on the History and Findings.Cushing’s SyndromeCushing’s
syndrome is caused by hypersecretion of adrenocorticotropic hormone (ACTH) by the
adrenal cortex either due to cortical hypertrophy or an abnormal growth of the adrenal
gland (Dunphy et al., 2019). It can also be caused by an intake of large doses of exogenous
glucocorticoid hormones (Dunphy et al., 2019). Analysis of the Differential based on the
History and Findings.Analyze the differential by using the pertinent findings from the
history and physical to argue for or against a diagnosis.Hypothyroidism (Hashimoto’s
thyroiditis)Pertinent Positives: Generalized fatigue, 5 lbs weight gain, cold intolerance, mild
depression, intermittent muscle cramping in calves, generalized weakness, and constipation
{Subjective findings}. Dry skin, coarse and thick hair {Objective findings}.Pertinent
Negatives: No complaints of hypersomnia, nausea, swelling, memory deficits, and
enlargement of neck. No facial swelling, hypoactive bowel sounds, and hyporeflexia.Major
Depressive DisorderPertinent Positives: Depression, generalized fatigue, “no energy” and
feeling tired all the time, generalized weakness, worsening of depressive symptoms, missed
1 day of work recently because “couldn’t get out of bed” and youngest child with bipolar
depression and ADHD and anxiety {Subjective findings}.Pertinent Negatives: Denies recent
stressful life events, denies suicidal/homicidal thoughts, denies headaches, alcohol and
substance abuse.Analysis of the Differential based on the History and Findings.Cushing’s
SyndromePertinent Positives: Weight gain, generalized weakness {Subjective
findings}. BMI=28.2 {Objective finding}.Pertinent Negatives: No complaints of back pain,
headaches, and skin changes. No objective findings of “moon face” appearance, and/or
“buffalo hump.”Rank the differential in order of most likely to least likely.Hypothyroidism
(Hashimoto’s thyroiditis)Major Depressive DisorderCushing’s SyndromeIdentify any
additional tests and/or procedures that you feel is necessary or needed to help you narrow
your differential. All testing decisions must be supported with an evidence-based medicine
(EBM) argument as to why it is necessary or pertinent in this case. If no testing is indicated
or needed, you must also support this decision with EBM evidence.Analysis of the
Differential based on the History and Findings.This patient is experiencing some of the
symptoms of overt hypothyroidism such fatigue, cold intolerance, increase in weight, dry
skin, and constipation (Rugge et al., 2014). The authors discuss how these nonspecific

4. symptoms can cause a life-threatening complication known as myxedema coma if the
patient has untreated hypothyroidism. It can also increase patient’s risk of coronary artery
disease, dyslipidemia, hypertension, obesity, and cognitive problems (Rugge et al., 2014). In
order to rule out thyroid disorder, it is important to screen patient for serum TSH, free T4,
and T3 (Rugge et al., 2014). I would like to order these blood tests for the patient in order
to help narrow my differential diagnosis.Analysis of the Differential based on the History
and Findings.