Please read the case study below and answer the following questions, then write a brief H&P for this patient.Also include evidence-based references.1] Top 5 Questions to ask this Patient to help Dx2] Top 3 Differential Diagnoses3] Physical Examination4] Screening Test for Depression5] Health Maintenance Specific to the Patient6] Evidence-based Treatment (Meds) and Plan for Care7] Brief SummaryCase Study
Samara is 42 yo woman who presents with stress and fatigue Samara lives with her husband and two children in a small house in Fairfield. She is a CNA at a local hospital and she works 32-hours a week. She recently switched from the day shift to nights in order to make a higher salary since her husband is at home at night now. Her husband was in the military for 10 years and has recently been discharged. He deployed to Afghanistan twice over the last few years, most recently to support the US leaving. He was on site to help the last groups leave in 2021.
Samara describes her stress as constant, mostly related to the changes over this last year in her household and her work. She has struggled with her weight since the birth of her youngest child who is now 8. Her last menses was about a month ago and her cycles are usually regular, monthly. She uses Depo-Provera and her last injection was in late August when she had her pap which was negative and her HPV was also negative. She was diagnosed with high cholesterol and pre-diabetes recently and is due for labs again in about 6 months. She wonders if there might be a medication that would help her feel more energetic so she can join the local gym and workout after work or on her days off. Her husband’s family is in Michigan and her family is mostly in Jordan. Her mother has diabetes and hypertension and her father has hypertension. She has a sister who lives in Southern California who is healthy.
Her vitals are 146/92, HR 76, RR 20
Her A1C was 6.7 in March and her total cholesterol was 229 (HDL 32 and LDL 120)
Her ROS was significant for fatigue, occasional constipation and weight gain of 12 lbs since last Spring. She sometimes she feels she has less patience with her family and she has trouble sleeping during the day on her work nights.
Her exam was mostly unremarkable except for mild acanthosis, her thyroid was mildly enlarged and she has severe tinea pedis between left great toe and first and second toes.
Your clinic has access to a psychiatrist and your role is to present, refer or consult according to your clinical findings.