Create a list of three to five

Create a list of three to five differential diagnosis (or you may develop a VINDICATE differential list if preferred) based on the patient’s presentation, HPI, and PE. Explain, for each differential diagnosis, what in the presentation, HPI, or PE led to your decision to select the differential diagnosis that you chose. Select the most likely diagnosis you think the patient could have and select a second possible diagnosis. Create a pathophysiology concept map/flow chart. In that flow chart compare and contrast these two diagnoses documenting how the two diagnoses are similar in looking at their symptoms, physical examination, and labs, and document how the two diagnoses are different. Also, answer these additional questions: Analyze and write a brief paragraph or list indicating what your differential diagnoses list could include (list all other possible diagnoses) if your patient is (1) 30 years old or if the patient were (2) a 79-year-old patient (ie, how might your ddx change in these groups?) Use evidence-based information with citations to support your answers. Save your flow chart to a file type that can be opened and viewed by your course instructor, which links the case patient’s symptom presentation and your chosen diagnosis. CC: 9-year-old boy in with parents with dry cough for 1 week. HPI: Started about a week after he had a cold. All symptoms resolved; however, the dry cough persisted. Denies any fever. Occasionally coughing fits so hard he has vomited. Coughing does seem to be worse at night or outside in colder weather. Tried Delsym with little improvement. Unsure about any sick contacts. This is the second time this has occurred since he was age 7. Last time he was provided an inhaler and his symptoms resolved after a week or so. PMH: No chronic conditions. No history of hospitalizations or surgeries. Meds: Minions chewable multivitamins, pediatric Claritin FH: Dad alive and well without any chronic conditions. Mom has history of seasonal allergies and asthma. Sister is healthy. SH: Lives with mom and dad and older sister age 11. Attends public school and in Grade 4. likes it and has lots of friends. Plays flag football. Denies any exposure to tobacco or smoke. NKDA, food, or material allergies + environmental allergies ROS: General: no fevers, weight changes, night sweats, fatigue Skin: denies rashes or changes in skin lesions. HEENT: denies vision changes or eye discharge, denies nasal congestion or sneezing, denies hearing changes or ear pain, tonight sore throat Cardio: denies chest pain Pulmonary: see HPI Abdomen: denies abdominal pain, denies nausea, vomiting, constipation, or diarrhea. 2 MSK/neuro: denies joint pain or loss of range of motion, denies numbness tingling that changes in sensation PE: General: alert, cooperative boy with parents, occasional dry cough VS: BP 109/80 RR15, P 70, T98.9, O2 Sat 98% RA ht 50in wt 75# Skin: Dry, intact without any lesions. HEENT: PERRLA, eyes clear, w/o discharge, TM’S intact, canals clear, mouth moist, w/o lesions, tonsils 2+ no erythema Heart: Regular rate and rhythm no murmurs rubs or gallops Lungs: wheezing throughout, no distress or no use of accessory muscles Abdominal: soft, round, non-tender to palpation POC: Peak Flow: 192 (goal is 240) Albuterol treatment now Following treatment, lungs less wheezy and peak flow: 210 SCIENCE

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