Discussion #1 · What is the CC in the case studies? What are important questions to ask the patients to formulate the history of present illness and what did the patients tell you? The CC in the first case study with Mr. Morales is diabetes management post heart attack and open-heart surgery a month ago. The important questions to ask is to find more information regarding current diabetes management and compliance to management. Open ended question allows practitioner to draw information from the patient (Dunphy, Winland-Brown, Porter, & Thomas, 2019). Starting with the question tell me more allows patient to elaborate more. Questions regarding blood glucose monitoring, medications, and compliance with medications would give insight of current diabetes management. Patient was saying his job as the reason for not being able to see provider at clinic and also not being able to check his blood sugar. Cost of testing strips. Patient has been checking his blood sugar since his heart attack, but worried he won’t be able to once the testing strip runs out. Mr. Morales also provides list of medications currently taken. Blood glucose readings are above 200 on days he didn’t take his insulin shot.  The CC in the second case study with Mr. Kaleb is rhinorrhea for 3-4 days. The use of mnemonics “OLDCARTS”, practitioner can get more information from the patients of present illness. The seven attributes of a symptom are critical to help understand presented illness which are Onset, Location, Duration, Character, Aggravating/alleviating Factors, Radiation, and Timing (Bickley & Szilagyi, 2017). The mnemonics “OLDCARTS” help provider ask the proper question to elaborate present illness. I would ask if there if there is anything that makes the symptom better or worse? If there are any other symptoms like shortness of breath and associated with current symptoms. Patient answered questions with medications that he tried for symptom relieves although non-effective. Mr. Kaleb have no shortness of breath and “feeling warm the first day but now I just have the chills occasionally.”  · What components of the physical exams are important to review in the cases? What are pertinent positive and negative physical exam findings to help you formulate your diagnosis? The physical exams that are important to review in Mr. Morales case are his vital signs and cardiac based on his recent heart attack. Extremities, neurologic, fundoscopic, and foot exam are important to assess in patient with diabetes. Patient continue with high blood pressure reading 150/90 indicates need for hypertension management. Positive findings of microaneurysm on bilateral eyes, hard exudates on the left are signs of diabetic retinopathy. Diabetic foot exam finds decreased sensation to monofilament and vibration to the mid-shin, onychomycosis, and +1 dorsal pedis and posterior tibialis pulses bilaterally. Exam was negative for foot ulcers. Findings suggest patient have neuropathy to his lower extr ...

1. Discussion #1
· What is the CC in the case studies? What are important
questions to ask the patients to formulate the history of present
illness and what did the patients tell you?
The CC in the first case study with Mr. Morales is diabetes
management post heart attack and open-heart surgery a month
ago. The important questions to ask is to find more information
regarding current diabetes management and compliance to
management. Open ended question allows practitioner to draw
information from the patient (Dunphy, Winland-Brown, Porter,
& Thomas, 2019). Starting with the question tell me more
allows patient to elaborate more. Questions regarding blood
glucose monitoring, medications, and compliance with
medications would give insight of current diabetes management.
Patient was saying his job as the reason for not being able to
see provider at clinic and also not being able to check his blood
sugar. Cost of testing strips. Patient has been checking his
blood sugar since his heart attack, but worried he won’t be able
to once the testing strip runs out. Mr. Morales also provides list
of medications currently taken. Blood glucose readings are
above 200 on days he didn’t take his insulin shot.
The CC in the second case study with Mr. Kaleb is rhinorrhea
for 3-4 days. The use of mnemonics “OLDCARTS”, practitioner
can get more information from the patients of present illness.
The seven attributes of a symptom are critical to help
understand presented illness which are Onset, Location,
Duration, Character, Aggravating/alleviating Factors, Radiation,
and Timing (Bickley & Szilagyi, 2017). The mnemonics
“OLDCARTS” help provider ask the proper question to
elaborate present illness. I would ask if there if there is
anything that makes the symptom better or worse? If there are
any other symptoms like shortness of breath and associated with

2. current symptoms. Patient answered questions with medications
that he tried for symptom relieves although non-effective. Mr.
Kaleb have no shortness of breath and “feeling warm the first
day but now I just have the chills occasionally.”
· What components of the physical exams are important to
review in the cases? What are pertinent positive and negative
physical exam findings to help you formulate your diagnosis?
The physical exams that are important to review in Mr. Morales
case are his vital signs and cardiac based on his recent heart
attack. Extremities, neurologic, fundoscopic, and foot exam are
important to assess in patient with diabetes. Patient continue
with high blood pressure reading 150/90 indicates need for
hypertension management. Positive findings of microaneurysm
on bilateral eyes, hard exudates on the left are signs of diabetic
retinopathy. Diabetic foot exam finds decreased sensation to
monofilament and vibration to the mid-shin, onychomycosis,
and +1 dorsal pedis and posterior tibialis pulses bilaterally.
Exam was negative for foot ulcers. Findings suggest patient
have neuropathy to his lower extremities.
In Mr. Kaleb case, the EENT and respiratory systems are
important to review in this case. The positive findings of
rhinitis and cough is important as well as the negative findings
of itchy, watery eyes, fever, purulent sputum, sinus and
maxillary tenderness, and no exudates or tonsillar enlargement
to rule out differential diagnosis.
· Which differential diagnosis is to be considered with each
case study? What was your final diagnosis?
The first case scenario with Mr. Morales there are multiple
chronic disease presented which are hyperlipidemia,
hypertension, type 2 diabetes, obesity, coronary artery disease
with history of heart attack. Patient’s main concern during this

3. visit is his type 2 diabetes making it the primary diagnosis. The
diagnoses of obesity, hypertension, hyperlipidemia, and type 2
diabetes frequently occur together (Dunphy, Winland-Brown,
Porter, & Thomas, 2019). The lifestyle changes these chronic
diseases are the same, therefore it would help improve all others
chronic diseases.
In Mr. Kaleb’ s allergic rhinitis, acute bronchitis, and viral
upper respiratory infection are the differential diagnosis.
Allergic rhinitis is unlikely since patient lack the symptoms of
sneezing, rhinorrhea, nasal obstruction, and nasal itching
(DeShazo & Kemp, 2019). With the early onset of disease, non-
productive cough, and afebrile, acute bronchitis is not
suspected. Viral upper respiratory infection is the final
diagnosis for Mr. Kaleb based on his symptoms and
examination.
Discussion #2
What is the CC in the case studies? What are important
questions to ask the patients to formulate the history of present
illness and what did the patients tell you? Mr. Morales
presented with a CC of “I had a heart attack about a month ago
and had to have open-heart surgery. The heart doctors told me
that my heart is weak now. My cardiologist told me that I have
to get my blood sugar under control so I don't have another
heart attack. I am here to get down to work.” Important
questions to ask the patient include dietary history, personal
willingness to adhere to treatments, current medications, and
medication compliance.
The patient reported that his diet was noncompliant with cardiac
and diabetic diet recommendations, noncompliant with daily
blood glucose checks and insulin administration. The patient did
express willingness to change and was open to treatments.
In the case of Mr. Taleb’s main CC was “"I have been sick for

4. the past three or four days. It started with my throat being
scratchy and lots of sneezing. Now my nose is all stopped up,
and I'm blowing it constantly. I'm also coughing a lot." For Mr.
Taleb it was important to ask questions to determine the onset
and duration of his symptoms, risk factors, any relevant
symptoms he has had. The patient’s answers revealed that he
had been exposed to his sick children; he was a smoker, no
fevers, rhinitis, sore throat, non-productive cough present at
night, lack of chest pain, myalgias, weight loss, hemoptysis or
dyspnea.
What components of the physical exams are important to review
in the cases? What are pertinent positive and negative physical
exam findings to help you formulate your diagnosis? In Case 1
the key components of the physical exam should include,
fundoscopic examination, foot exam, neurologic, abdomen, and
cardiac systems. In the case of Mr. Morales he presented with
blurry vision which can indicate diabetic retinopathy. Diabetic
retinopathy is a common microvascular complication of type 1
and type 2 diabetes affecting over 3 million people globally
(Dugan, J.2017). Glycemic control is necessary to the
prevention of diabetic retinopathy. Assessing for skin integrity
and foot ulcers is imperative in diabetics.
For case 2, Mr. Taleb’s physical exam should include visual
examination of the throat, as well as a full HEENT exam. This
is important to determine if his cold symptoms are bacterial or
viral. Assessing for fevers, productive or nonproductive cough,
and lung sounds are necessary to determine whether antibiotics
are warranted. Mr. Taleb had not fevers and had clear drainage,
antibiotics were not warranted.
Which differential diagnosis is to be considered with each case
study? What was your final diagnosis? For Mr. Morales the
most likely differential diagnoses include Diabetes Mellitus
Type II, uncontrolled Hyperglycemia, uncontrolled
hypertension, dyslipidemia. My final diagnosis for Mr. Morales
would be Diabetes Mellitus Type II. Mr. Morales did originally
present to the hospital with a non-ST elevation myocardial

5. infarction and required three vessel coronary artery bypass
grafting, but his present issue to his PCP was uncontrolled
diabetes.
For Mr. Taleb URI, allergic rhinitis, and acute bronchitis were
the most likely diagnosis. Do not use antibiotics for
uncomplicated acute bronchitis in adults, regardless of duration
of cough, due to modest benefit and potential harms
(Petrovic,M.S. (2019). A viral upper respiratory infection was
my final diagnosis. The patient did not present with a fever,
productive cough which ruled out pneumonia. The throat was
not very red with no exudates, no purulent nasal discharge,
sinus tenderness, ruling out strep throat, sinus infection is
unlikely. Antibiotics for uncomplicated acute bronchitis and
URI in adults, regardless of duration of cough, due to modest
benefit and potential harms are contraindicated (Petrovic,M.S.
(2019).