INSTRUCTIONS: Discussions require a response to a specific question(s), which re


INSTRUCTIONS: Discussions require a response to a specific question(s), which results in a collaborative conversation(s) and construction of knowledge, which build(s) on and expands your learning in this course. With each discussion, you can support your postings and responses with specific references to the assigned course readings and websites. Post your initial response to the discussion question(s) by no later than (Monday), December 5, 2022 at 11:59 pm Pacific Standard Time (PST). With proper citation and reference list in APA format. Substantive first reaction to two other posts is due by Wednesday on December 7, 2022 at 11:59 pm (PST). With proper citation and reference list in APA format. Substantive reply to the reactions to your posts are due by Friday on December 9, 2022 at 11:59 pm (PST). Write a conclusion of your posts by Sunday, December 11, 2022 at 11:59 pm (PST). Answer the questions with proper citations in APA format. Provide a reference list. CLINICAL CASE Chief Complaint “Dizziness and hearing difficulty.” History of Present Illness A 64-year-old man presents to his PCP complaining of intermittent episodes of dizziness occurring over the past year. The dizziness, described as a spinning sensation, comes every 1 to 2 weeks and generally lasts for 6 to 12 hours. These episodes often are accompanied by nausea and vomiting. He has more recently noticed hearing fluctuations, especially in his left ear. The hearing loss is worse just before and during attacks and then improves. He also now describes a sense of aural fullness and tinnitus, described as a low-frequency blowing or roaring sound in the ear, associated with the episodes. He attributes these symptoms to noise exposure with his work. He has taken over-the-counter meclizine to help with the dizziness, with some relief of the symptoms. Review of Systems The patient’s ROS is positive for vertigo, tinnitus, hearing loss, nausea, and vomiting. He has occasional headaches that respond to treatment with acetaminophen. His ROS is negative for fever, chills, weight loss, or fatigue. Relevant History The patient has had no major illnesses, injuries, surgeries, or hospitalizations. He is a lifelong nonsmoker and drinks one to two glasses of wine per week. He is employed as a high school music teacher and plays in a band part-time on weekends. The patient is married and has three grown children who are all in good health. His family history is significant for hypertension in both parents. There is no family history of cancer, early heart disease, or diabetes. Allergies No known medical allergies; no known drug allergies. Medications •Meclizine 25 mg PO TID OTC, PRN. •Acetaminophen, 500 mg PRN. Physical Examination Vitals: T 37°C (98.6°F), P 76, R 14, BP 132/82, HT 177.8 cm (70 in.), WT 81.65 kg (180 lbs), BMI 25.8. General: Well-developed and nourished 64-year-old male patient in no acute distress. Psychiatric: Appears mildly anxious. Skin, Hair, and Nails: Skin warm and dry, no rashes or bleeding tendency. No abnormal findings with hair or nails. ENT/Mouth: TMs appear pearly, gray with no fluid noted. Hearing is decreased in the left ear as compared to the right on gross testing. Oral mucosa is moist; dentition in good repair with no caries or erosions. Neck: Supple with no adenopathy or thyroid enlargement. Lungs: Clear to auscultation bilaterally. Heart: RRR, without murmur, gallop, or rub. Abdomen: Soft with no masses, organomegaly, or tenderness. Active bowel sounds heard in all quadrants. Neurologic: Alert and oriented ×3; immediate, recent, and remote memory intact; Cranial nerves II–XII grossly intact; strength 3/5 and DTRs 2+ symmetrical in all extremities; sensation, coordination, balance, cerebellar function, and gait intact. CLINICAL DISCUSSION QUESTIONS 1.What is the differential diagnosis? 2.What is the most likely diagnosis? Why? 3.Demonstrate your understanding of the pathophysiology in regard to the most likely diagnosis. 4.Should tests/imaging studies be ordered? Which ones? Why? Think about tests/imaging beyond the primary care setting as well. 5.What are the next appropriate steps in management? 6.Review a credible research article(s) about this diagnosis. Demonstrate your understanding of the prevalence, diagnostic criteria, and treatment options. Include a list of your reference(s). 7.What are the appropriate patient education topics for this case? 8.Think about interprofessional collaboration for this case. Provide a list of specialties or other disciplines and indicate what contribution these professionals might make to managing the patient.


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