Running Head: Comparison and contrast 2 Comparison and contrast 2 Post Concussive Syndrome and Traumatic Brain Injury Student’s Name Instructor Affiliation Date Requirements: Week 2: Case Discussion: Pulmonary Part One  Setting: A free medical clinic that provides health care for the under-insured. Your next patient, Michelle G., age 40, is a regular of the clinic and the last patient of the day. The chart states she is here for recent episodes of shortness of breath.  You enter the room and Michelle G is dressed in work clothes, standing up looking at a health poster on the wall. You introduce yourself and ask her what brings her to the clinic today. "I think I may have a cold. I've been having a hard time breathing on and off lately."  HPI: "I notice I'm short of breath mostly at work but by the time I get home feel fine. No episodes of shortness of breath on the weekends that I can recall. But a few hours back at work and I start to feel like I cannot catch my breath again. A few months ago this happened and it was so bad I left work and went to urgent care where they gave me a breathing treatment of some kind and sent me home on an antibiotic. I would like you to give me another antibiotic. She denies sputum. No new allergy triggers noted. She denies heartburn.  PMHx: Michelle G. reports her overall health as good.  Childhood/previous illnesses: eczema as a child  Chronic illnesses: Has seasonal allergies, spring is her worst season. Was seen by an allergy specialist ten years ago, Took allergy shots for five years with great results, now only takes Zyrtec when needed.  Surgeries: Cholecystectomy  Hospitalizations: childbirth x 3.  Immunizations: up-to-date on all vaccinations.  Allergies: Strawberries-Rash; erythromycin- severe GI upset.  Blood transfusions: none  Drinks alcohol socially, smoked 1 pack per week for 3 years in her 20's. Denies illicit drug use.  Sleeps 6 to 7 hours a night. Exercises four to five days per week.  Current medications: Multivitamin, Zyrtec  Social History: Married, lives with husband and 3 children. Worked in advertising up until 18 months ago when she got laid off. In order to help with the household finances she took a job as a Baker's assistant at an Artisan Bread Bakery. She arrives at 4 a.m. every morning to begin baking breads/pastries for the day.  Family History: Children are healthy- daughter currently has a sinus infection. Parents are deceased. Mother at age 80 from congestive heart failure. Father died at age 82 from lung cancer, diagnosed when metastasized to brain. PGM: died from unknown causes, PGF: Stroke at age 82. MGM: died at 83, had HTN, atherosclerosis and many heart attacks. PGF: died at 71 from complications of COPD.  PE: Height 5'10", Weight 140 pounds  Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA  General: 40-year-old Caucasian female appears stated age in no apparent distress. Alert, oriented, and cooperative. Able to speak in full sentences and does ...

1. Running Head: Comparison and contrast 2
Comparison and contrast 2
Post Concussive Syndrome and Traumatic Brain Injury
Student’s Name
Instructor Affiliation
Date
Requirements:
Week 2: Case Discussion: Pulmonary Part One
Setting: A free medical clinic that provides health care for the
under-insured.
Your next patient, Michelle G., age 40, is a regular of the clinic
and the last patient of the day. The chart states she is here for
recent episodes of shortness of breath.
You enter the room and Michelle G is dressed in work clothes,
standing up looking at a health poster on the wall. You
introduce yourself and ask her what brings her to the clinic
today. "I think I may have a cold. I've been having a hard time
breathing on and off lately."

2. HPI: "I notice I'm short of breath mostly at work but by the time
I get home feel fine. No episodes of shortness of breath on the
weekends that I can recall. But a few hours back at work and I
start to feel like I cannot catch my breath again. A few months
ago this happened and it was so bad I left work and went to
urgent care where they gave me a breathing treatment of some
kind and sent me home on an antibiotic. I would like you to
give me another antibiotic. She denies sputum. No new allergy
triggers noted. She denies heartburn.
PMHx: Michelle G. reports her overall health as good.
Childhood/previous illnesses: eczema as a child
Chronic illnesses: Has seasonal allergies, spring is her worst
season. Was seen by an allergy specialist ten years ago, Took
allergy shots for five years with great results, now only takes
Zyrtec when needed.
Surgeries: Cholecystectomy
Hospitalizations: childbirth x 3.
Immunizations: up-to-date on all vaccinations.
Allergies: Strawberries-Rash; erythromycin- severe GI upset.
Blood transfusions: none
Drinks alcohol socially, smoked 1 pack per week for 3 years in
her 20's. Denies illicit drug use.
Sleeps 6 to 7 hours a night. Exercises four to five days per
week.
Current medications: Multivitamin, Zyrtec
Social History: Married, lives with husband and 3 children.
Worked in advertising up until 18 months ago when she got laid
off. In order to help with the household finances she took a job
as a Baker's assistant at an Artisan Bread Bakery. She arrives at
4 a.m. every morning to begin baking breads/pastries for the
day.
Family History: Children are healthy- daughter currently has a
sinus infection. Parents are deceased. Mother at age 80 from
congestive heart failure. Father died at age 82 from lung cancer,
diagnosed when metastasized to brain. PGM: died from
unknown causes, PGF: Stroke at age 82. MGM: died at 83, had

3. HTN, atherosclerosis and many heart attacks. PGF: died at 71
from complications of COPD.
PE: Height 5'10", Weight 140 pounds
Vital signs : BP 130/70, T 98.0, P 75, R 18 Sao2 98% on RA
General: 40-year-old Caucasian female appears stated age in no
apparent distress. Alert, oriented, and cooperative. Able to
speak in full sentences and does not appear breathless. Skin:
Skin warm, dry, and intact. Skin color is pale pink, no cyanosis
or pallor.
HEENT: Head normo-cephalic. Hair thick and distribution even
throughout scalp.
Eyes: Sclera clear. Conjunctiva: white, PERRLA, EOMs intact.
Ears: Tympanic membranes gray and intact with light reflex
noted. Pinna and tragus non-tender
Nose: Nares patent with thin white exudate noted. Mucosa
appears boggy and pale. Deviated septum noted. Sinuses non-
tender to palpation.
Throat: Oropharynx pink, moist, no lesions or exudate. Tonsils
1+ bilaterally. Teeth in good repair, no cavities noted. Tongue
smooth, pink, no lesions, protrudes in midline. Neck supple. No
cervical lymphadenopathy or tenderness noted. Thyroid midline,
small and firm without palpable masses.
Lungs: Lungs clear to auscultation bilaterally. Respirations
unlabored. Slight wheezing noted inspiration and on forced
expiration. Wheezing does not clear with forced cough.
CV: Heart S1 and S2 noted, RRR, no murmurs noted, no
displaced PMI. Peripheral pulses equal bilaterally, no peripheral
edema
Abdomen: Abdomen round, soft, with bowel sounds noted in all
four quadrants. No organo-megaly noted.
Diagnostic Testing:
Review of the patient's EMR reveals an old CXR from last
winter when she had Bronchitis.
CXR Report: 11/7/2016
This is a PA and lateral chest radiograph on Ms. Michelle X,
performed on 11/7/16. Clinical information: low grade fever,

4. productive cough, malaise.
Findings: Cardio-mediastinal silhouette is normal. B/L lung
fields are clear. There are no effusions. The bony thorax
appears normal. No opacities or fluid. Diaphragm normal.
Impression: Normal chest radiograph without pathology.
Click here to view CXR (Links to an external site.) (Links to an
external site.)
You suspect an obstructive/restrictive process and order
Pulmonary Function Testing
Pre-Bronchodilator Challenge- FEV1/FVC 60%, FVC decreased
Post Bronchodilator Challenge- FEV1/FVC 75%
Discussion Questions Part One:
1. What is your primary diagnosis for Michelle given the pattern
of occurrence of symptoms, exam results, and recent history?
Include the rationale and a reference for your diagnoses.
2. What is your first-line treatment plan for Michelle including
medications, labs, education, referrals, and follow-up? Identify
the drug class of each medication you prescribe and exactly
what symptom it is targeted to address.
3. Address Michelle's request for an antibiotic.
DISCUSSION CONTENT
Category
Points
%
Description
Application of Course Knowledge
25
42%
Post contributes clinically accurate perspectives/insights
applicable to the results from the physical exam and diagnoses.
Initial post includes the most likely diagnosis/specific treatment
plan given case study information supported by rationale and
answers all questions presented in the case. Demonstrates
course knowledge/assigned readings by: linking
tests/interventions accurately to diagnoses, applies learned

5. knowledge specifically to the symptoms and patient information
using original dialogue i.e., little to no direct quotes.
Evidence Based resources
15
25%
Discussion post supported by evidence from appropriate sources
published within the last five years. Focus of journal articles
represents a logical link between the article content and the case
study information. In-text citations and full references are
provided.
Interactive Dialogue
10
17%
Presents case study findings and responds substantively to at
least one peer including evidence from appropriate sources, and
all direct faculty questions posted. Substantive posts contribute
new, novel perspectives to the discussion using original
dialogue (not quotes from sources)
50
84%
Total CONTENT Points= 50 pts
DISCUSSION FORMAT
Category
Points
%
Description
Organization
5
8%
Discussion post presented in a logical, meaningful, and
understandable sequence. Headings reflect separation of

6. criterion outlined in assignment guidelines.
**Direct quote should not exceed 15 words & must add
substantively to the discussion
APA/Grammar/Spelling
5
8%
Discussion post has minimal grammar, spelling, syntax,
punctuation and APA* errors. Direct quotes (if used) is limited
to 1 short statement** which adds substantively to the post.
* APA style references and in text citations are required;
however, there are no deductions for errors in indentation or
spacing of references. All elements of the reference otherwise
must be included.
10
16%
Total FORMAT Points= 10 pts