Reference no: EM133510614

Vance is a 25-year old Hispanic male being seen at the primary care clinic today for a sick visit related to complaints of cough. His chief complaint today is, "My cough is getting worse, and now my chest hurts." He presents with a 2-day history of left-sided pleuritic chest pain, intermittent fever and chills, and a cough productive with yellow sputum. The chest pain radiates to the proximal left upper quadrant during coughing. He has not experienced nausea or vomiting. He also states that this morning he experienced rhinorrhea and a sore throat, which are "a little better right now." He has had asthma since childhood, which is "usually in good control." He ran out of his albuterol and has not been using it for some time. He denies a history of past surgeries or trauma. He states he has not had any vaccines "since high school." Both of Vance's parents are living. His father (age 62) has hypertension. His family history is negative for coronary artery disease, asthma, diabetes, and cancer. Vance quit smoking cigarettes 3 months ago, and has been vaping for the past 3 months. He reports alcohol use, two glasses of wine on weekends when dining out. Vance is a car salesman and has never been married. He denies illicit drug use. He states he smokes "an occasional cigar with friends." Vance has lived in the US since he was 2-years old. He was born in Mexico. He is Catholic, but does not attend church regularly.

1. What other focused history questions must be asked to complete the history for this patient? You need rationale (and perhaps a reference) for the questions you select.

2. How can you incorporate a patient-centered approach in completing the history for this patient?

3. What focused physical examination will you perform?

4. What cultural factors could affect your physical assessment?

5. How can you ensure effective communication with your patient/family?

6. What labs/diagnostics should be obtained or ordered for this patient (if any)? What ethical concerns would you consider when ordering these?

7. Identify THREE Differential Diagnoses, with rationale, for this patient. Discuss the process of ruling out differentials to make your final differential diagnosis.

8. Identify relevant health promotion/patient education topics to cover with the patient/family at this time. Provide rationale to support the selected interventions.